Investigating health and social outcomes of the Big Local community empowerment initiative in England: a mixed method evaluation

Empowerment

Many contemporary understandings of empowerment link it to improvements in individual self-help. For example, in the health field it is linked to personal management of chronic health conditions and/or the adoption of ‘healthier’ behaviours. In contrast, drawing on the work of Freire and Gramsci6,7 and the civil rights and feminist movements of the 1960s and 1970s, others understand empowerment as involving sociopolitical processes that support people bearing the brunt of social injustice to exercise greater collective control over decisions and actions impacting on their lives and health, and in so doing, contributing to greater social equity in society. As Eyben puts it: ‘empowerment happens when individuals and organised groups are able to imagine their world differently and to realise that vision by changing the relations of power that have kept them in poverty, restricted their voice and deprived them of their autonomy’. 8

Like empowerment, ‘control’ is often understood as an individual outcome of successful empowerment. ‘Collective control’, in contrast, is presented as the outcome of successful empowerment at a community or group level, when people act together in their common interest. As we describe in Chapter 7, in the CiC study, the capabilities associated with collective control have been operationalised as different forms of power. 9

Examples of this more political expression of community empowerment find their most radical form in the popular epidemiology examined by Brown,10,11 where people spontaneously and collectively respond to resist a shared threat to their well-being. Brown has studied local people’s resistance to exposure to toxic waste, including, for instance, the action by residents in Woburn, Massachusetts, to try to prove a link between industrial toxins in their water supply and high rates of childhood leukaemia. 10

These different understandings of empowerment sit at the extremes of a continuum along which the significance varies between a focus on individual self-help versus collective action; on changes in personal circumstances/behaviour versus in proximal living and working conditions; of action to increase internal capabilities of individuals/groups to improve their lives versus action on wider political and social change for greater equity.

Elsewhere we have argued that the construct of collective control understood as the outcome of empowerment processes has greater analytical and practical advantage for health policy and practice than the commonly used concept of ‘community empowerment’. 9 In particular, it can help move policy, practice and research beyond the ‘inward gaze’ dominating many contemporary community initiatives, which focuses on developing the internal capabilities of disadvantaged communities in order to better enable them to ‘cope’ with their proximal living circumstances. This inward gaze is embedded, for example, in concepts such as community competencies, capacities, assets, resilience and social capital. Clearly, it is important that people experiencing the brunt of inequalities (however defined) are supported to develop their internal capabilities. It is also important, however, that this inward gaze is complemented by an ‘outward gaze’ aimed at supporting communities to mobilise these capabilities to collectively take more control over the external structures and conditions that drive social, economic and health inequalities. The concept of collective control helps strengthen this outward gaze by placing power and social change at the centre of place-based policy and practice.

Community

The term collective also avoids the ambiguous and contested concept of community. 12 Some 50 years ago, Bell and Newby identified 98 different definitions of community. 13 As Dominelli notes, communities ‘are constantly changing entities with shifting and contested boundaries … because individuals belong to more than one community simultaneously.’14 Communities are self-defined and can be international, national or local. They provide a sense of belonging for ‘members’ sharing an affinity to a particular place, interest or identity but can feel exclusionary to those who do not ‘meet’ the membership criteria. Communities can also be deeply gendered. Women are primarily responsible for constructing the threads that bind local place-based communities together – albeit the relational work they do in these communities is often invisible.

For much of the past 25 years, public policy and practice focused on reducing social and health inequalities in England has been dominated by a focus on place-based communities and particularly people living in the most disadvantaged neighbourhoods. However, as we discuss in the next section, there have also been significant differences in the nature of these policies over time.

Background

In 2010, the National Lottery Community Fund (then Big Lottery Fund) announced funding of £271M for the BL programme. The scale of funding allocated, although small compared to government-funded initiatives such as NDC (approximately £2B over 10 years), was the largest ever investment by a non-government funder in a place-based community empowerment programme, and in 2020 remained ‘the biggest ever single-purpose National Lottery-funded endowment’. 80

Following a tendering process,81 the Community Development Foundation was appointed to lead a consortium of national organisations to set up a new organisation that would act as the Corporate Trustee for a BL Trust. 82 Consequently, Local Trust (LT) was formed, taking over management of BL from the original consortium in March 2012. Figure 1 outlines the relationship of BL to its key entities: the funder (Big Lottery/National Lottery Community Fund), LT, BL Trust and the legal protector (providing stewardship of the BL Trust). BL Trust was set up as a charitable trust with a jointly agreed trust deed between the National Lottery Community Fund and LT. 83 LT is the sole corporate trustee of the BL Trust. In its role, LT ensures BL is delivered in a way that is in keeping with the trust deed. A key stipulation of the deed was that the total endowment should be committed by a date about 10 years from when the trust was set up, subsequently agreed to be 2026. 83 The trust deed also requires the use of BL funding to be additional to public funding for activities that national/local government is required to provide as part of statutory functions.

FIGURE 1.

Relationship between key BL programme entities. Reproduced with permission of Local Trust.

Selection of areas to be included in the Big Local programme

In total, 150 areas in England were selected for funding in three waves (July 2010, February 2012 and December 2012). The Big Lottery Fund decided on the areas following consultation with local partners (e.g. local authorities). 84 Local areas were selected on the basis that they had historically missed out on lottery and other community funding. 80 Early guidance published in 2010 indicates that the targeted localities were ‘all places where many people face multiple barriers to meeting their needs, and which have not had great success in gaining resources to help’. 81 While all BL areas are relatively disadvantaged, in practice they vary across a range of geographical and demographic characteristics, with local populations ranging from 3000 to 12,000, with most being between 6000 and 7000. There is also considerable variation in the extent to which BL area boundaries are contiguous with pre-existing formal or social boundaries (e.g. a ward or housing estate). 2 Earlier phases of the CiC study found that this influenced the speed and nature of early roll-out of the programme in local areas. 2 This included the ways in which residents were able to engage with other residents and professionals and act collectively to make decisions about how to spend the £1M to improve their neighbourhood. 3

Big Local programme outcomes and framework

The funder set four outcomes for the BL programme, which are listed below. These were intentionally broad, enabling local communities to set their own priorities:81

1. Communities will be better able to identify local needs and take action in response to these.

2. People will have increased skills and confidence so that they continue to identify and respond to needs in the future.

3. The community will make a difference to the needs it prioritises.

4. People will feel that their area is an even better place to live.

Once established, and in consultation with partners, LT developed a programme theory and framework to guide the delivery of BL locally. Central to this was a seven-stage pathway which all areas are expected to move through, albeit iteratively and at their own pace. Although LT no longer refers explicitly to a ‘pathway’ in its guidance for local areas, these key components of the programme framework, shown in Box 2, remain in place.

Initially, each local area received a small grant of £20,000 to consult with residents and produce their plans. Across areas, engagement, consultations and plan development occurred approximately in the first 2 years, before BL partnerships began to draw down the main grant after their initial plans were endorsed by LT. Although there is no formal time frame for expenditure by local areas (e.g. no set date for submission of local plans), all BL partnerships had had their first plan endorsed by 2015. Each area has been allocated approximately £1.1M over time, with an additional £50,000 released to each area in March 2020 to enable BL partnerships to provide additional support to local communities during the pandemic. These additional funds are derived from growth in the BL Trust endowment, which is invested.

National support and management functions for Big Local

Local Trust, and national organisations commissioned by them, provide a range of support for BL partnerships. Firstly, each BL area receives professional support through a BL rep who acts as a ‘critical friend’, helping BL partnerships to develop and deliver their plans. Reps also contribute to a two-way flow of information between LT and the BL partnership; for example, disseminating information about new opportunities (e.g. events, training) as well as updating LT on progress or local issues. Secondly, each BL partnership is required to identify a LTO to manage its funds; these include organisations such as community voluntary services, local civil society organisations, housing associations and parish councils. While not compulsory, many BL partnerships also employ people or organisations to undertake specific tasks (e.g. to run engagement events and/or manage projects). Thirdly, partnerships can secure optional support or expertise such as training and learning opportunities for residents and organisations involved in BL and topic support related to delivering plans (e.g. social investment, managing land assets). Finally, network events are organised nationally and regionally to encourage the exchange of knowledge between BL partnerships and organisations with relevant expertise. We do not have the space in this report to describe the wide range of approaches adopted in BL areas to engage the wider population in the programme – we have written about these elsewhere85 – nor the diverse actions taken to improve the neighbourhoods, which are described on the LT website (https://localtrust.org.uk).

While the broad programme framework described above has remained constant over time, the speed of spend has varied across BL areas. Some are likely to have spent all their funding before 2026; other areas have spent more slowly. Additionally, our fieldwork in this third phase of CiC has identified ways in which programme arrangements have evolved over time, from early stages of set-up to delivering plans and spending money. These changes are explored in more depth in Chapter 4.

The Big Local intervention start date

The areas in which the programme was implemented were selected between 2010 and 2012 and received a small grant in the initial period, but most did not start to draw down substantial amounts of money until their plans were approved in 2015. For the analysis of population impacts, we therefore defined 2016 as the start date – that is, the earliest date from which it is plausible that the BL initiative could start to have an impact on population health outcomes. We examined the timing of impacts using alternative start years in the analysis (see below).

Data and sample size

The analysis utilised data from the ONS APS for the years 2011–1990,91 and various secondary sources. The APS is the largest representative household survey in the UK, with a sample size of 320,000. It combines data from four successive quarters of the Labour Force Survey with rolling-year data from the English, Welsh and Scottish Local Labour Force Survey. The sampling frame is the Royal Mail postcode address file and the NHS communal accommodation register, and sampling is stratified to ensure it is representative at the regional level. Where possible, every adult aged 16 and over in a household is interviewed. Where there are other individuals in the household who can answer on behalf of an absent respondent, proxy responses are also collected. Well-being measures (see Outcomes below) are only collected on non-proxy respondents, of which there are approximately 165,000 per year. New respondents in the sample are interviewed face to face, while subsequent interviews are conducted over the telephone where possible.

We used the secure access version of this data set which includes an indicator of the Lower Super Output Area (LSOA) of each respondent. LSOAs are small geographical areas used by the UK’s ONS, each typically containing a population of about 1500 people. This LSOA indicator was used to identify respondents in BL and in comparator areas (see below). This provided a total sample of 26,440 non-proxy respondents in BL areas and 75,580 in comparator areas from 2011 to 2019 (see Appendix 1, Table 13 for annual sample sizes). This was similar to our estimated sample size in our pre-registered protocol of 108,000 respondents over the 9 years. We used simulation methods to investigate the power that this sample would provide across a range of effect sizes, taking into account weights for the study design and using robust clustered standard errors to account for clustering within areas and serial correlation in the data. 92

As Table 1 shows, we would be able to detect an absolute reduction of two percentage points in our primary outcome – the proportion of the population reporting high levels of anxiety – with a power of 83% (at α = 0.05). A two-percentage-point reduction would mean that the proportion of the population reporting high levels of anxiety drops from the estimated baseline level of 21% to 19% in BL areas. For the analysis of secondary outcomes, we used a number of routine data sources to construct a panel of aggregate data for the 880 LSOAs that lie within BL areas and the matched 2640 comparator LSOAs over 9 years (2011–19), providing 31,680 observations for the analysis. These data are based on the total populations and not a sample survey.

Outcomes and control variables

Outcome 1: Our primary outcome was high levels of anxiety self-reported in the APS, measured as the proportion of people reporting a score of > 6 in response to the question ‘Overall, how anxious did you feel yesterday?’, where 0 is ‘not at all anxious’ and 10 is ‘completely anxious’. A threshold of > 6 on the 11-point scale has been identified by the ONS as a measure of high anxiety levels. 93

Outcome 2: The Small Area Mental Health Index (SAMHI) is a composite annual measure of population mental health that we developed for each LSOA in England. The data and methods used to compile the index are available through the open data portal Place-based Longitudinal Data Resource. 94 The SAMHI combines data on mental health from multiple routine sources into a single index, including antidepressant prescribing data from NHS Digital,95 mental health-related hospital attendances as defined below, diagnoses of depression in primary care from the Quality and Outcomes Framework,96 and claims for Incapacity Benefit and Employment Support Allowance for mental illness. 97 Each indicator was individually standardised by rescaling data to have a mean of 0 and a standard deviation of 1 (z-scores). Maximum likelihood factor analysis was used to combine these indicators (by finding appropriate weights) into a single score based on the intercorrelations between all the indicators. The SAMHI is an indicator of poor mental health; a higher score indicates worse population mental health.

Outcome 3: Antidepressant prescribing measured as the average daily quantity of antidepressants prescribed per 1000 population per year using general practitioner (GP) practice prescribing data provided by NHS Digital. 98 This indicator was standardised by rescaling data to have a mean of 0 and standard deviation of 1 (z-scores).

Outcome 4: Mental health-related hospital attendances per 1000 population using Hospital Episode Statistics provided through a data sharing agreement with NHS Digital (DARS-NIC-16656-D9B5T-v3.10). This measure consists of A&E attendances and admitted patient care for alcohol misuse, drug misuse, self-harm, and common mental disorders. Specifically, it includes a count of all admissions with a primary diagnostic ICD-10 code of X60*–X84*, Y10*–Y34*, F00–F99, E244, F10, G312, G621, G721, I426, K292, K70, K852, K860, Q860, R780, T510, T511, T519, X45, X65, Y15, Y90, Y91 but excluding Y33.9*, and Y87*, plus a count of all A&E attendances for self-harm (codes 141–144, 35, 37) in each year for each LSOA, divided by the annual population estimate. This indicator was standardised by rescaling data to have a mean of 0 and standard deviation of 1 (z-scores).

Outcome 5: Recorded crimes and incidents of antisocial behaviour (ASB) per 1000 population for the offence categories violence and sexual offences, burglary, criminal damage and ASB using Open Data from the UK government. 99 The combined indicator was used and additionally each category of crime was analysed separately. These indicators were standardised by rescaling data to have a mean of 0 and standard deviation of 1 (z-scores).

Outcomes 6–8: We also included the three other measures of subjective well-being included in the ONS well-being set – ‘low satisfaction’, ‘low happiness’ and ‘not worthwhile’ – measured as a score of < 7/11 in response to the questions: ‘Overall, how satisfied are you with your life nowadays?’, ‘Overall, how happy did you feel yesterday?’ and ‘Overall, to what extent do you feel that the things you do in your life are worthwhile?’.

In analysis of the APS, we used age and sex plus a number of variables to adjust for potential confounders. Respondents were defined as employed if they reported that they were either an employee or self-employed in the survey week. Socioeconomic status was defined using the National Statistics Socioeconomic Classification (NS-SEC),100 grouped into three categories: (1) higher managerial, administrative and professional occupations; (2) intermediate occupations; and (3) routine and manual occupations or never worked/long-term unemployed. Respondents were defined as coming from a black, Asian or other minority ethnic group if they identified as Asian/Asian British mixed/black/African/Caribbean/black British/Chinese/Arab/multiple ethnic groups/other ethnic group. Education status was defined in three categories based on highest educational qualifications: (1) degree or equivalent, (2) some qualifications but less than a degree, or (3) no qualifications. Marital status was defined as married/civil partnership or other. Respondents were defined as having a disability if they reported a long-standing illness that limited work or other daily activities. We also used survey data on housing tenure. Survey questions related to education and disability are only asked for respondents of working age (aged 16–64) and therefore these variables were only included in analysis limited to this age group.

Matching to define the comparison areas used data on Index of Multiple Deprivation (IMD) 2015 domains of income, health, crime and environment;101 the Community Needs Index 2019 developed by LT;102 the ethnic and age profile of the population using data from the 2011 census; the average distance to the nearest GP practice, hospital and green space, using data from the Access to Healthy Assets and Hazards Index (AHAH),103 the distance to the coast; the ONS area classification based on eight subgroups (affluent England; business, education and heritage centres; countryside living; ethnically diverse metropolitan living; London cosmopolitan; services and industrial legacy; town and country living; and urban settlements);100 and region.

As additional control variables in the LSOA level analysis we used annual estimates of the distance to the nearest GP practice and hospital to account for potential changes in access to health services that might lead to bias in our outcomes that are based on health service utilisation (antidepressant prescribing and mental health-related hospital attendances). To account for potential divergence in the trends in economic conditions in BL and comparator areas, we additionally controlled for the annual unemployment claimant rate using data from the Department for Work and Pensions. 97

Statistical methods

Firstly, we defined our comparator areas based on a set of LSOAs matched with the LSOAs included within BL areas. The entire population of the intervention area (150 BL areas) consists of 880 LSOAs. Each of these intervention LSOAs was matched with three control LSOAs located within England, providing 2640 matched control LSOAs. We used propensity score matching104 to ensure that these comparator areas had similar observed characteristics to the intervention LSOAs in the time period before the start date for the intervention (2011–15). The matching was based on the variables outlined above, along with the prior values of the four secondary outcomes (SAMHI, antidepressant prescribing rate, mental health related hospital admissions, recorded crimes). The nearest neighbour method was used for matching, which selects controls with propensity scores that are closest to that of the intervention LSOAs.

We then used difference-in-differences (DiD) methods105 to compare the change in health and social outcomes in BL areas to those in non-BL areas. The estimate of the effect of the BL programme was therefore calculated as the difference between the change in the outcome in the BL areas and the change in the outcome in the comparator areas. This DiD approach uses a comparison both within and between areas – accounting for secular trends in our outcomes and unobserved time-invariant differences between areas that could confound findings. The primary assumption is that trends in outcomes would have been parallel in the BL and comparator areas in the absence of the BL programme. This is a reasonable assumption as the comparator areas are very similar to the BL areas at baseline and therefore likely to be affected in a similar way as the BL areas by wider national factors such as welfare reforms, austerity measures and economic change.

This involved estimating a regression based on the following formula:

where Yiat is the outcome reported by individual or LSOA i in area a at time t, BLa is a dummy variable taking the value 1 for BL areas and the value 0 for the comparator areas, and AFTERt is a dummy variable taking the value 1 for time periods after 2015. Xiat is a vector of control variables for individual/LSOA i in area a at time t. The coefficient of interest is β₃, the coefficient on the interaction term AFTERt∗BLa, sometimes referred to as the DiD parameter. It indicates the change in outcomes in the BL areas relative to the change in outcomes in the comparator areas, that is, the effect of the programme on the outcome. As this interaction term cannot be interpreted as the programme effect in non-linear models, we used linear regression models, even for our binary well-being outcomes, to estimate the DiD parameter. 106 To check the robustness of this approach, we additionally estimated logistic regression models for the binary outcomes and then calculated the contrast of the predicted margins from these models, that is, the equivalent to the interaction term in a linear model. 106

Subgroup and lagged and lead analysis

To investigate differences in effect by sociodemographic conditions, the analysis of our primary outcome using APS data was repeated for subgroups defined by socioeconomic status, ethnicity and for the working-age population (16–64 years). The analysis of our secondary outcomes was repeated for subgroups of BL areas, as the LSOA-level data provided sufficient numbers of observations in each subgroup’s BL area. This subgroup analysis was not possible with the primary outcome, as the APS sample within each BL area was not sufficient.

The analysis of subgroups of BL areas included rematching each subgroup to a comparison group of areas to ensure balance was maintained within subgroups. To investigate whether effects differed according to the scale and type of activity in each BL area, we repeated the analysis including only those BL areas that had spent more than 80% of their grant by 2019/20 (30 BL areas). These areas had progressed furthest with implementation and therefore we might expect that any effects on social and health outcomes would be greatest in these areas. To investigate whether differences in the type of activities in each BL area influenced outcomes, we repeated the analysis for four groups of BL areas defined by the type of activities they prioritised for expenditure. These activities were classified into a fourfold typology based on the determinants of health that they targeted: economic (e.g. money advice, poverty reduction and skills development interventions), social (e.g. arts and culture, community spaces, loneliness interventions), environmental (e.g. community safety, housing and transport interventions) and lifestyle (e.g. sport and physical activity, and health and well-being interventions).

Most BL areas prioritised funding of activities across more than one of these types, and so we replicated our analysis for each group if they had included that activity type in their offer (e.g. environmental interventions). So BL areas could be included in more than one group if they included activities across multiple types in their offer. To understand potential combined effects of the scale and types of activity on outcomes, we repeated the analysis for our four groups of BL areas defined by their type of activity, while also limiting this analysis to those that had spent more than 80% of their grant.

To investigate whether contextual factors influence the effectiveness of the BL programme and potential impacts on social and health outcomes, we repeated the analysis for: (1) three groups of BL areas defined by baseline deprivation using the IMD 2015 income domain score; (2) three groups defined by the proportion of people from ethnic minority groups; and (3) three groups based on the age profile of the population (proportion of people under 16 and over 75).

We also checked the timing of impacts using lags for the 2 years after the BL implementation start date of 2016 and investigated whether impacts happened before this implementation year using leads for the 3 years before this date. Finally, to examine the sensitivity of our models to dichotomising the well-being outcomes, we repeated the analysis for the full scale (0–10) for all four well-being outcomes.

Data sources

This WP used data from three waves (2016, 2018 and 2020) of a biannual longitudinal survey of those most actively engaged in BL – all BL partnership members in all 150 BL areas. This was conducted by LT. As already noted, BL partnerships have a majority of resident members plus members from local organisations including the local authority, the NHS, and/or faith and other third-sector organisations.

A survey is delivered by the LT every 2 years, online and by post, to all the individuals actively involved as the members of the 150 BL partnerships in England. These include non-residents and residents. We refer to the latter in our reporting as ‘active residents’. The survey was initially developed internally by LT to meet programme and learning requirements of the organisation. However, through our partnership with LT, the CiC research team were able to add additional questions relating to mental well-being, self-rated general health, collective and/individual control, social cohesion and area perception. The BL partnership survey is a repeat cross-sectional survey. Although the survey was conducted in 2014, it was only in 2016 that we were able to insert questions on health, place or experience of collective control. For our purposes, the first-wave survey was therefore in 2016 (baseline, wave 1). Potential respondents were identified using a common sampling frame: all BL partnership members who submitted contact details (over 1200) as part of the annual partnership review carried out by LT were approached via e-mail (for an online questionnaire submission). BL reps were also sent physical copies of questionnaires by post to distribute, to reach as many other partnership members (~400) as possible. This gave a total potential sample of over 1600 partnership members across all 150 BL areas. A total of 862 participants submitted a completed wave 1 questionnaire in 2016, a baseline response rate of over 50%. In 2020 (wave 3), the questionnaire was distributed – online only – to all 1664 current partnership members, and 1018 responses were received, leading to a response of around 61%. These repeated samples provided the basis for a nested cohort, whereby individual records were linked over the three waves (2016, 2018 and 2020). As anticipated in our proposal, the final sample size of the nested cohort was small, with only 217 participants providing linked data over all three waves, and so we also analysed the total responses at each wave using a repeat cross-section design. The repeat cross-sectional survey had samples of n = 862 in wave 1, n = 1011 in wave 2 and n = 1023 at wave 3. Our analytical sample at each wave (comprising those who provided responses across all our variables) was 500, 654 and 636. The analyses also looked separately at resident and non-resident partnership members.

Types of Big Local programmes

Using data provided by LT, we were able to undertake subgroup analyses on the basis of the extent and type of BL activity in each of the 150 BL areas. We used a threefold classification of the amount of funds spent on activities up to 2019/20 – low (spent ˂ 50% of £1M), medium (spent 50–80% of the £1M) and high spend (spent > 80% of the £1M) – and the fourfold typology of activities described earlier. This was based on the determinants of health that BL expenditure targeted: economic (e.g. money advice, poverty reduction and skills development interventions), social (e.g. arts and culture, community spaces, loneliness interventions), environmental (e.g. community safety, housing and transport interventions), and lifestyle (e.g. sport and physical activity, and health and well-being interventions). Most BL areas funded activities across more than one of these groups. In the WP2 analyses, outcomes for partnership members in areas that included a specific expenditure type in their programme plans were compared to those in areas that did not include that specific type but had planned expenditure in any/all of the other three activity groups.

Obtaining and managing the data

Local Trust collated the survey responses and sent them to the research team in an anonymised SPSS (IBM Corporation, Armonk, NY, USA) spreadsheet in October 2018 and October 2020 (we already had baseline data from 2016 from earlier phases of CiC). 107 The anonymised data were uploaded to a shared Box folder which was only accessible to named collaborators. Individual records were linked over the three waves via unique numerical identifiers for the purpose of the nested cohort. The repeat cross-sectional element included area-level data linkage. The data were stored in electronic form on secure university servers and were accessed through password-protected networked PCs and laptops.

Outcome measures

The survey collected data on the characteristics of BL partnership members [demographic data, socioeconomic status (education), perception of individual and collective control and perception of the BL area, levels of participation (number of unpaid hours per week on BL activities) and self-perceived health] using two validated measures: the Short Warwick–Edinburgh Mental Well-being Scale (SWEMWBS) and Census General Health. A copy of the questionnaire is included in the accompanying project documentation.

Our primary outcome was the score from SWEMWBS, which is designed to measure positive mental health states (as opposed to symptoms of mental ill-health such as anxiety and depression). The scale has seven domains, and scores range from 7 to 35, with higher scores indicating higher positive mental well-being. The scale has been validated for the general population. 108 Questions include the degree to which a participant ‘feels useful’ or ‘feels relaxed’, or agrees with the statements ‘I think that I deal with problems well’, ‘I feel close to other people’ and ‘I have been able to make up my mind about things’.

Our secondary outcome was ‘self-rated general health status’ (the census measure), which asks ‘How is your health in general? Would you say it was very good, good, fair, bad, very bad?’ This was recoded with ‘very good’ and ‘good’ coded as ‘good’ and fair, and with ‘bad’ and ‘very bad’ coded as ‘not good health’.

Explanatory variables

Based on our theory of change, engaged residents could be expected to experience improvements in mental well-being and general health as a result of reductions in social isolation as they participate in BL activities, through an improved perception of community, as well as through feeling that they have greater control over decisions that affect their daily lives. At baseline, we therefore examined any association for our two health outcomes with: (1) whether respondents felt able to influence decisions affecting their area, either with others (collective control) or as individuals (individual control); (2) social cohesion around involvement (feels good to know more people in the area, feels more connected, feels more positive about BL area, feels stronger sense of community) and area perception (feels people in the BL area can be trusted, feels people in their BL area are willing to help each other, feels they belong to the area); and (3) hours of involvement among participants. Only the explanatory variables that were significantly statistically associated with our primary outcome at baseline were then included in the follow-up analyses. Typology data on the extent and type of BL activities in different areas were also included in the follow-up analysis to examine whether different levels of expenditure or types of activity were more/less associated with any changes in our primary outcome.

Analysis

We examined whether our primary and secondary health outcome measures changed over time across the three waves using both the repeat cross-sectional and cohort designs.

National fieldwork

The national fieldwork was built upon interviews conducted in 2014 in phase 1 of the CiC study with representatives from national organisations involved in the consortium that established BL. These interviews were completed approximately 2 years into the programme when BL areas were establishing local partnership boards and identifying priorities. In this third phase of CiC, EH conducted 10 further stakeholder interviews over two waves. Participants were identified from programme documentation, advice from LT and the research team’s knowledge and links with national organisations. Participants included stakeholders directly involved in BL nationally and/or with knowledge of the national policy context for places and communities.

The semistructured interviews at each wave shared a common focus on understanding the nature of the BL programme model. Wave 1 interviews (n = 6) were completed in spring 2019. Two of these respondents were also interviewed in 2014. Four further interviews took place 18 months later and included two participants interviewed in wave 1. Three further participants were also approached but either declined to take part or did not respond to the e-mail, despite follow-up reminders. These second-wave interviews also explored perspectives on BL’s position within national policy developments, particularly in the context of the unfolding pandemic. Key organisations (e.g. LT) were represented in the sample during each wave of fieldwork. All participants agreeing to take part were approached by e-mail and provided with an information sheet at least 24 hours in advance of the interview and completed written informed consent before the interview. CiC wave 1 interviews took place face-to-face, and all interviews in wave 2 were conducted virtually via Microsoft Teams^® (Microsoft Corporation, Redmond, WA, USA).

Recordings of wave 1 interviews were transcribed by a professional transcriber, with wave 2 interviews transcribed using automated transcription in Microsoft Teams. All transcripts were checked for accuracy, anonymised to remove personal identifiable information, and then uploaded to NVivo 12 (QSR International, Warrington, UK). Analysis combined thematic coding in NVivo with memo writing, drawing out different perspectives on the programme and how it had changed over time and the factors influencing this. Findings from this work are presented in Chapter 4.

Local fieldwork

The local fieldwork was undertaken by researchers based in Newcastle, Sheffield, Lancaster, London, Liverpool and Devon. To support this dispersed team, guidance was produced to facilitate consistent ways of working and ensure that the procedures and processes set out in our Research Ethics application were followed. Methods utilised in this work are described below, and the findings are presented in Chapters 7 and 8.

The qualitative fieldwork focused on:

1. tracking residents’ attempts to exercise collective control over decisions/actions to improve their neighbourhoods – termed critical collective control episodes (CCEs)

2. exploring residents’ subjective perceptions of the impact of their collective action on their health and well-being and that of other residents

3. illuminating the processes operating (within and beyond BL areas) to amplify and/or dampen the impact of these attempts by residents to act collectively and their perceptions of pathways to health impacts at individual and population levels.

We had also planned to collect data on the nature and scale of additional resources (cash or in kind) attracted into BL neighbourhoods, but this was not possible. We were, however, able to obtain some information on this from LT.

The fieldwork was based in a sample of BL areas selected in phase 1 of the CiC study. These are described briefly in Appendix 2. They were identified and recruited through LT, with BL reps facilitating contact with the partnerships in each area. The sites were originally selected on the basis of three criteria: (1) geographical spread across England (NW, NE, SW, Yorkshire and Greater London) and urban/rural split; (2) initial 10 areas selected in 2014 to reflect diversity in local context and population; (3) a further five areas added in 2015 to reflect diversity in the local plans. Data collection for the research reported here comprised two waves of interviews and observations. Efforts were made to follow up with people interviewed in earlier phases of the CiC study, whether still actively involved in BL or not. Unfortunately, 1 of the 15 original fieldwork sites declined to engage in this phase of the research, and in a second area, respondents were unable to participate in the second wave of data collection due to the disruptions of the pandemic.

Data analysis

Recordings of the first wave of interviews were transcribed by a professional transcriber; most interviews conducted online were transcribed using automated transcription in Microsoft Teams or Zoom. All transcripts were checked for accuracy, anonymised to remove personal identifiable information and uploaded to NVivo-12. All transcripts were coded using a common framework developed collaboratively by the research team, drawing on analysis from previous phases of CiC. Coding also allowed emerging concepts to be captured. Consistency checking was conducted using NVivo’s inter-rater reliability test function. 109

Once all transcripts were coded, detailed longitudinal analyses were conducted to address relevant study objectives. These centred on: (1) the measurement of changes in capabilities required for communities to develop collective control; (2) pathways to collective control and the factors that enabled or constrained the development of these capabilities and their exercise by residents; and (3) residents’ perceptions of pathways to health impacts and the impact of involvement in BL on their own health and well-being. Approaches to these analyses are described below.

Internal developments: Big Local support and management functions

In interviews conducted in 2019, informants connected to LT highlighted key developments in the programme centrally. While these changes involved substantive remodelling of BL’s support and management, those interviewed also emphasised that the programme’s ‘fundamentals’ remained unchanged:

the fundamentals are still there in terms of how Big Local areas engage with the Big Local programme, you know … long-term … resident-led, non-judgemental, light-touch support from reps. [however], nearly all of the delivery architecture, the structures that support that have been reviewed and changed over the last 24 months.

CiC3-Nat-Interview-13-W1

Three key changes to delivery architecture are outlined below.

Developments in places’ and communities’ policy

Reflecting on the decade since BL was launched, participants pointed to a changing focus on place and communities within the English policy landscape. This was firstly explained in relation to the localism agenda pursued by the coalition government since 2010. While this agenda emphasised a changing relationship between national and local government, it also had salience for initiatives such as BL to the extent that localism emphasised communities taking control, and Brexit reinforced this:

I mean I think Big Local came at a very particular political moment when [Cabinet Minister] wanted to devolve a lot and part of that was bypassing local authorities … I think the Brexit vote did shift policy interest into place. It sort of became fashionable … to start talking about place as mattering and communities as mattering … actually, I think it’s the Brexit vote that sharpened that …

CiC3-Nat-Interview-17-W2

However, participants also highlighted practical and ideological issues linked to these developments. For example, one participant expressed uncertainty as to the extent to which localism policies – such as neighbourhood rights and asset transfers – had genuinely reached or benefited local communities. Other participants suggested there was ambiguity in the framing of key concepts such as ‘left-behind’ neighbourhoods – a term increasingly used within national policy rhetoric following the EU vote. Participants suggested this context presented a window for learning from programmes like BL to more proactively inform developments within the unfolding public policy landscape.

Growing policy-focused work in Local Trust

Since 2017, LT’s work to more proactively influence policy developments has been evident in a range of ways, including establishing a new policy team and encouraging the transfer of learning from BL to other national organisations. As noted already, a revision to the trust deed has also enabled greater investment in ‘telling the story of BL’ with a view to disseminating lessons more widely.

Respondents were asked about the ways in which BL was perceived to be contributing to the development of thinking and policy at the national level. There were frequent comments on this increased external profile compared to BL’s early years, which had been largely concerned with the internal organisation and delivery of the programme. As one participant, involved in BL and interviewed in 2014 and then again in 2019, observed: ‘there is a lot more learning and sharing and everything going on’ (CiC3-Nat-Interview-02-W1).

One example of policy influence is LT’s involvement in establishing a new alliance campaigning for a Community Wealth Fund. The aim of the alliance is to dedicate dormant assets (from stocks, shares, bonds, insurance and pension policies) to create a new, independent endowment. It has generated considerable interest, with 400 members now signed up. There is also evidence of political interest in the idea, illustrated, for example, by the proposal for a Levelling Up Communities Fund in MP Danny Kruger’s Levelling Up Our Communities Review (September 2020),35 which shares similarities with the Community Wealth Fund. The work LT commissioned in 2019 on the nature and geography of ‘left-behind’ neighbourhoods, and specifically the paucity of social infrastructure in these areas, is another notable example of policy influence. 102 Following the dissemination of the report, they were appointed as secretariat for an all-party parliamentary group for left-behind neighbourhoods in 2020.

Austerity and welfare changes

Austerity and welfare changes were highlighted as having a significant impact on residents in BL areas; this was a finding observed across the different waves of fieldwork. Firstly, in a context of deepening public sector cuts, there was growing evidence of BL partnerships supplementing or supporting services previously delivered by local councils.

At first a huge number of areas would have said … ‘Oh we are not going into supplementing sort of like services that the local authority should be providing’. But as time has gone on and with austerity, they have found that they are doing that – they are providing youth services for example and they have realised that really if they didn’t do it then … it wouldn’t be happening at all.

CiC3-Nat-Interview-12-W1

Others suggested that changes to welfare systems were impacting resident engagement in BL:

One of our research partners … did some research into the impact of welfare reform in some of the Big Local areas – so massive increase in use of food banks, lots of people being displaced through the bedroom tax and people being too distracted by all of that to want to participate and get involved.

CiC1-Nat-Interview-10-W2

Such factors were perceived as also having a bearing on residents’ sense of collective control. The following participant observed that while BL funding enabled residents to exercise some control over external factors shaping living conditions in their areas, this could simultaneously be disempowering, changing the dynamic between residents involved in the BL partnership and those in receipt of BL support.

[T]hat feels sometimes and comes across as a … bit of the like Lady Bountiful kind of, oh no let’s provide some food …. That’s not the sort of relationship that you want … residents on partnerships to have with the wider community, to feel that there is this sort of, like, this powerful group of people who can then bestow you know the means of life to another person who is in the community. That really wasn’t in the plan.

CiC3-Nat-Interview-12-W1

EU referendum and Brexit

A second major development has been the EU referendum, followed by the UK’s departure from the EU. Different views were expressed on its significance for local areas during the study time frame. Participants largely spoke of its heightening political attention to places where a majority of the local population had voted to leave. At the time of the interviews, however, the UK’s imminent departure from the EU was not viewed as a particularly prominent issue for local partnerships. Nevertheless, one participant suggested that some BL areas could be disproportionately impacted by the economic consequences of Brexit:

I think stuff like that [job losses] will impact. But when you go out and visit them [BL areas] at the moment, [I] don’t sense that’s something that people have on their mind.

CiC3-Nat-Interview-13-W2

The COVID-19 pandemic

The final wave of interviews was conducted a number of months into the pandemic when events were still unfolding and the longer-term effects were relatively unclear. Participants reflected on the ways in which communities involved in BL had proactively responded to the pandemic, a theme also covered in Chapter 7. In light of the need for all funds to be spent by 2026, some concern was expressed about the effects of the pandemic on the rate of expenditure, particularly in areas already struggling prior to the pandemic.

when there were issues before COVID happened, COVID only made those issues worse …. The partnerships just weren’t doing anything, weren’t making decisions at all, and in some of those areas it’s been difficult … so we will have to have a look.

CiC3-Nat-Interview-12-W2

Main analysis

Table 7 provides the descriptive statistics for respondent characteristics and the health and explanatory outcomes for the repeat cross-sectional study across all three waves of the survey (2016, 2018 and 2020). The mean mental well-being score was 24.2 (± 4.2) at baseline, rising to 24.7 (± 4.1) at wave 2 and falling to 23.8 (± 4.2) at wave 3 (see further information in Appendix 4, Table 26). The proportions reporting good self-rated health were 74.35%, 68.9% and 70.2% at waves 1, 2 and 3 respectively.

In the analysis, we included the two explanatory factors that were significantly associated with our health outcomes at baseline: ‘willing to help’ and ‘collective control’. 107 We also included resident status and hours volunteered. Across all three waves, over 80% agreed that people in the area are willing to help each other, and over 80% of respondents agreed that they have collective control over decisions in their area. Residents of BL areas made up 70% of the participants, and the average number of hours volunteered per week on BL activities was around six.

The final fully adjusted parsimonious model in Table 8 shows the associations between our explanatory factors and our primary outcome of mental well-being among the BL partnership members (split by resident status). The results show that compared to baseline mental well-being score in 2016 (20.20, 95% CI 18.18 to 22.21), there was no overall significant change in the mental well-being of participants or resident participants at wave 2 in 2018 (22.32, 95% CI 20.49 to 24.15) or wave 3 in 2020 (19.67, 95% CI 17.35 to 21.99) (see further information in Appendix 4, Table 27). However, those who perceived that people in the area were willing to help each other had a significantly higher mental well-being score at wave 3 (1.1, 95% CI 0.59 to 1.67). Similarly, those who agreed that collectively they can influence decisions in the area had a higher mental well-being score at wave 3 (3.4, 95% CI 1.5 to 5.2). Results were similar for resident and non-resident members of the BL partnerships.

Subgroup analysis by education level

The subgroup analysis by education level also found that there was no significant difference in 2018 or 2020 in mental well-being by education level (see Appendix 4, Table 28). However, participants with a degree who felt that people in the area were willing to help had a two-unit higher mental well-being score in 2020 (2.10, 95% CI 0.28 to 3.91), while those in the lower educational group who agreed that they had collective control had a 2- to 4-unit higher mental well-being score in 2018 and 2020 than those who did not (no degree = 4.65, 95% CI 1.92 to 7.38).

Subgroup analysis by gender

The subgroup analysis by gender found no significant difference in 2018 or 2020 in mental well-being for men or women (see Appendix 4, Table 27). However, more highly educated women had a slightly higher mental well-being score in 2020 (30.52, 95% CI 0.26 to 1.03) (Appendix 4, Table 28) compared to lower educated women in 2020. For women who agreed that people in the area were willing to help, their mental well-being score was higher in 2016 (2.55, 95% CI 1.01 to 4.10), but not in 2018 or 2020, than for women who did not agree. Likewise, the mental well-being score among women agreeing that they had collective control was higher across all three waves compared to women who did not agree. There was no association for men between agreeing that people in the area were willing to help and mental well-being score. For men, those agreeing that they had collective control had higher mental well-being scores in both 2018 (3.96, 95% CI 1.44 to 6.48) and 2020 (5.79, 95% CI 2.34 to 9.08).

Self-reported general health

For the secondary outcome of self-reported general health, analysis of the repeat cross-sectional sample used a GEE model (adjusted for age, sex, ethnicity, educational qualifications, number of hours volunteered). This showed that over the study period, there was no significant change in good health in 2018 or 2020 (see Appendix 4, Table 29). This did not differ by resident status.

Nested cohort

Big Local intervention typologies

For the nested cohort analysis, we also examined associations with the two BL intervention typologies: spend (low, medium, high) and type (environment/social/economic/lifestyle). The amount of spend in the BL area had no association with mental well-being (see Appendix 4, Table 30: high –1.45, 95% CI –3.25 to 0.35; medium –0.97, 95% CI –2.56 to 0.63; low = reference). In terms of the type of activities prioritised in an area (see Appendix 4, Table 31), only the environmental activity type was significantly associated with mental well-being (1.15, 95% CI 0.10 to 2.20).

Subgroup analysis by education

The subgroup analysis by education found that there was no significant difference in 2018 or 2020 in mental well-being for those without a degree-level education (see Appendix 4, Table 32). However, for those with one or more degrees (see Appendix 4, Table 33), there was an increase (1.99, 95% CI 0.14 to 3.84) in mental well-being in 2018, but no significant difference in 2020. In both educational groups, those with higher hours volunteered had a very small increase in mental well-being (no degree = 0.06, 95% CI 0.01 to 0.11; degree = 0.11, 95% CI 0.04 to 0.18). Likewise, in both educational groups, those participants who agreed that they had collective control had a higher mental well-being score than those who did not (no degree = 2.77, 95% CI 0.38 to 5.17; degree = 2.71, 95% CI 0.02 to 5.41). Mental well-being scores for residents with a degree were higher (2.29, 95% CI 0.22 to 4.36) than for non-residents with a degree.

Subgroup analysis by gender

The subgroup analysis by gender found that there was no significant difference in 2018 or 2020 in mental well-being for women (see Appendix 4, Table 34). Men had a significant increase of > 2 units (2.41, 95% CI 0.55 to 4.28) in mental well-being score in 2018 but not 2020 (see Appendix 4, Table 35). The mental well-being score among men agreeing that they had collective control was much higher (4.91, 95% CI 2.36 to 7.46) than men who did not agree, while for female participants, mental well-being score was significantly higher (1.64, 95% CI 0.48 to 2.79) among those who agreed that people in the area are willing to help each other compared to women who did not agree. For both male (0.20, 95% CI 0.12 to 0.28) and female (0.02, 95% CI –0.02 to 0.07) participants, there was a small positive association between hours volunteered and mental well-being score.

For the secondary outcome of self-rated health, analysis of the nested cohort sample used a GEE model (adjusted for age, sex, ethnicity, educational qualifications and number of hours volunteered). This showed that over the study period, there was no significant change in the odds of respondents reporting not good health in 2018 (OR 0.63, 95% CI 0.17 to 2.29) or 2020 (OR 0.53, 95% CI 0.14 to 1.47) (see Appendix 4, Table 36). This did not differ by resident status.

The Communities in Control power frameworks

In phases 1 and 2 of the CiC study, we produced two frameworks to aid in the operationalisation of the concept of collective control and the barriers to its development. Their development is described in more detail elsewhere. 9 The frameworks are adapted from the work of others, drawing on learning from earlier phases of CiC and a systematic literature review of theories by Whitehead et al. 37

The emancipatory power framework (EPF) shown in Box 3 comprises a power lens through which capabilities for collective control, and changes in these, can be understood and assessed. It draws upon the concepts of ‘power within’, ‘power with’ and ‘power to’ (previously developed and applied at the individual level)118–121 and theoretical literature on empowerment. 122–125 However, much of the framing in this literature is instrumental, focusing on the ‘ingredients’ needed to achieve more effective empowerment, or focused at the level of individuals. The CiC EPF is distinguished by its focus on collective capabilities,126 developed within and by communities to exercise greater collective control.

‘Power within’ refers to collective capabilities internal to a community, including recognition of shared values and interests. ‘Power with’ refers to the power emerging when a community acts with other agencies or communities to achieve common ends. ‘Power to’ refers to collective capabilities associated with implementation of community action. Interactions between the EPF dimensions are non-linear, although development and exercise of ‘power to’ and ‘power with’, initially at least, require some degree of ‘power within’, and changes in one power domain will feed back into others. These dimensions reflect an understanding of power as generative, expansive and ‘non-dominating’, emanating from relationships with others. 127

The CiC limiting power framework shown in Box 4 is adapted from a typology developed by Barnett and Duvall in 2005. 128 It identifies four forms of power that can be used to restrict the development and exercise of collective control by disadvantaged communities of interest/place. Importantly, these forms of power are not always used illegitimately, and individuals/groups in these communities can use them to exercise ‘control’ over others in the same community.

‘Compulsory power’ is direct and visible: it can involve physical, psychological or economic force. ‘Institutional power’ is less visible, exercised through organisational rules, procedures and norms. ‘Structural power’ works invisibly through institutions such as the law, the labour market and education, creating and sustaining hierarchical structures (e.g. social class, gender/sexuality and race/ethnicity) through which resources, opportunities and social status are distributed. ‘Productive power’, in contrast, operates through social discourses and practices, with institutions (e.g. the media, politics, law, medicine, and education) legitimising some forms of knowledge/discourse while marginalising others. From the perspective of this research, ‘place stigma’ is one of the most relevant consequences of the illegitimate exercise of the productive form of power.

Assessing changes in capabilities for collective control

If the concept of collective control capabilities, understood as different forms of power, is to be of benefit to health research policy and practice, ways to identify and measure these capabilities at the level of the collective are needed. Collective impacts/outcomes, however, by their very nature, cannot be captured adequately by simply aggregating measures of psychological empowerment of individuals in a community or group. 56,129 We need measures that capture the dynamics of interactions within and between the collective, on the principle that the whole is greater than the sum of its parts. 130 In a recent review, Laverack and Pratley also confirmed that ‘standard quantitative indicators are insufficient to measure the complexity of the concept’ and advocate combining these with some form of rapid qualitative assessment. 131 In phases 1 and 2 of the CiC study, we took up the challenge and identified qualitative markers of changes in the different forms of power as they occurred in the first three years of BL. In this third phase of CiC, we have begun to elaborate further on these markers based on our most recent qualitative research in these neighbourhoods. This part of our analysis has been severely disrupted by impacts of the pandemic on our research team and is still ongoing, but our analysis of phase 2 and 3 primary data has both begun to reveal new empirical markers against the three dimensions of the power framework and has led to the addition of milestones marking the evolution of collective control capabilities through three main programme stages: initial implementation, development and bedding in. We thus adapted and extended our initial qualitative markers to become ‘progress markers’. The original markers of collective control capabilities are illustrated in Box 5, together with examples of the newly identified progress markers (depicted in emboldened text).

Taking the example of the dimension ‘power within’, a BL partnership might progress from ‘drawing together existing skills and expertise’ in the initial implementation stage of a community empowerment programme to meeting the milestone ‘developing perspective, the ability to prioritise and put community needs first’ in the developmental stage and finally to ‘developing qualities such as emotional resilience and a professional persona’ (which could be individual or collective) in the bedding-in stage. In another example in the ‘power within’ column, a BL partnership might be seen to progress from ‘increasing group efficacy and confidence’ during implementation to ‘evolving as a partnership and gaining autonomy’ as the programme is bedded in.

Pathways to collective control

Our research has illuminated different dimensions of the complex pathways BL residents traverse in seeking to develop and exercise collective control over decisions and actions that aim to improve their neighbourhood and the lives of local people. In this section, we consider these pathways from three perspectives. First, we consider the impact of internal dynamics in the governance space associated with BL partnerships. Second, we adopted a wider lens exploring the pathways BL residents followed as they attempted to deliver changes in the area, and the barriers and enablers they encountered along the way. These findings are based on longitudinal analyses of the qualitative interviews in four case study areas – eight in total. As described in Chapter 3, these interviews explored perceptions of processes enabling or constraining residents’ attempts to act collectively to improve their area and the impact they felt BL was having in the area, on the local population and on their own health and well-being. Third, we look at how the BL partnerships in our 14 fieldwork areas responded to the COVID-19 pandemic. This analysis involved qualitative interviews from the second wave when respondents were specifically asked about the impact of COVID-19 on the work of the BL partnership. Details of the methods used in these analyses are provided in Chapter 3.

The internal dynamics of Big Local partnerships

In phase 1 of the CiC study, we examined how BL partnerships emerged as governance spaces in the early stages of the programme. 132 We described the ways in which residents initially began working as a group brought together by the BL rep and/or other local stakeholders, with the expectation of having a 51% resident majority. These earlier findings revealed how residents began ‘taking charge’, reflecting growing power within the BL partnership and how the initial setting-up of governance structures, such as a code of conduct and constitutions, helped BL partnerships develop power with others by constructing themselves as a legitimate forum with which external, professional stakeholders can engage. 132

We have continued to explore how BL partnerships evolved as governance spaces since those early years as they navigated internal and external issues arising from the implementation of their plans in local areas. In this recent analysis, we have used Connelly’s framing of ‘legitimacy’ – a ‘property constructed in and through specific processes of governance’133 – to consider how partnership members sought to transfer their emerging ‘power within’ into ‘authority’ recognised by external stakeholders. 133 The analysis considers two types of legitimacy: process (or input) legitimacy – gained through how the process of decision-making is defined – and substantive (or output) legitimacy – gained through the outcomes of the decision-making process. 134 In large part this analysis has focused on governance, understood as structures and processes that enable partnership members to make decisions about how the BL money would be spent, determine who will act on behalf of BL, and be accountable to the local population and the national oversight organisation (LT) for delivering improvements in the area. However, it is also important to recognise that these governance spaces were also the location for a great deal of relational work by partnership members that moved beyond the work required for the practising of governance.

Four cross-cutting themes reflect different dynamics of the enactment of governance and can be argued to have shaped the development of capabilities for collective control in BL partnerships and contributed to external perceptions of their legitimacy: (1) representation and the movement of actors through the governance space; (2) mechanisms and tools of governance; (3) external expectations for governance; and (4) memories and legacies of governance.

External dynamics: relationships in delivering of change

The previous section focused on the internal dynamics of the BL partnership governance spaces. Here we adopt a wider ‘external’ lens that focuses on residents’ experience of being involved in significant attempts to deliver improvements in their neighbourhood and how the barriers and enablers they encountered along the way impacted on the exercise of collective control. As described in Chapter 3, these findings are based on thematic analysis of qualitative and observational data within and across four case study areas.

Moving online

The main factor constraining partnership work was the implications of the national lockdown for face-to-face meetings. Some partnerships did not connect online at all as they were not comfortable engaging with online meeting platforms. This was particularly evident during the early stages of the pandemic.

We’ve not had a lot of contact with each other through COVID. So, a lot of people … are from the era where Zoom calling is not for them.

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Some paid workers responsible for supporting the partnership were furloughed by their employing organisation; for example, staff paid for by the BL partnership but employed through the LTO, which further exacerbated difficulties. Those partnerships that did meet online still experienced disruption as both partnership members and employed staff adjusted to new ways of working:

Working from home … slowed everything down massively because it wasn’t the norm.

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Having the Zoom meeting while trying to put them [children] to bed is enough to drive anyone crazy.

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However, after an initial period of adjustment, some BL partnerships reported positive changes to group dynamics when using online meeting platforms. For example, one BL paid worker suggested in positive terms that online meetings had allowed the partnership to ‘have that connection, the face to face without being face to face’ (A12-BLW-18-P3-W2), while a BL rep argued that pre-existing relationship problems ‘were actually easier to deal with over Zoom’ (A5-Rep-P3-W2).

An unexpected outcome where partnerships had embraced social media as a communication tool was an increased awareness of BL work in the wider community. This may have been because people were generally spending more time online during lockdown and because partnerships were engaging in these different forms of communication – for example, Facebook (Meta Platforms, Inc., Menlo Park, CA, USA) and Slack (Slack Technologies, LLC, San Francisco, CA, USA) for outreach and WhatsApp (Meta Platforms, Inc.) groups for informal communication between partnership members.

We are seeing a real boost online this year. It might be the amount of page likes; the amount of people coming; it’s like people posting on our page and things like that. People are definitely aware of who we are and what My [BL name] is about.

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Restricting activity

A particular disappointment for many partnership members and local people was the cancellation of planned events, such as festivals and excursions. Prior to COVID-19, such events could be central elements of partnership work, providing fun activities and connecting local people, as well as giving BL partnerships visibility in the community.

I have people asking when are the trips and I said forget it. We’re not looking at anything properly now till next year.

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Other planned projects were impacted by disruptions in partner organisations. One LTO worker describes the implications for building work that was due to commence at the beginning of the first lockdown:

Everything went on standstill. It took builders a long time to provide all the documents that the housing association needed …. They then furloughed all their staff so we didn’t have many people that we could deal with at the builders.

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There were also areas of work that were seen to be not amenable to online working. Outreach youth work was highlighted in this context, because of a mismatch between the type of online platforms BL partnerships and youth workers had access to and those that young people were most likely to use. This BL worker describes the difficulties faced by a colleague in an outreach role:

The raison d’être of his job was about face-to-face contact with young people and he can’t do that as much. He’s doing a bit of it but it has to be socially distanced and properly managed. So, he’s doing a lot of online stuff and the ones that are classified as hard to reach are even more difficult to reach because they’ll do Instagram or TikTok but they won’t do Zoom or come into a Teams meeting run by Microsoft if we paid them.

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Adapting activity and shifting perspectives

While mainstream BL work was extremely limited by the COVID-19 restrictions, some BL partnerships ‘really jumped into action’ (A8-RPM-P3-W2). Galvanised by the crisis, they started to contribute to humanitarian support for people who were shielding or otherwise struggling with basic needs.

They set up from the Hub and started making food isolation packs for the elderly and vulnerable residents and then delivered them out in the village and they were receiving referrals also from the borough council as well and taking out emergency supplies to people that were continuing to contact them directly.

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Some partnerships approached organisations they were funding in order to maximise the local response. As this BL worker explained:

I got in touch with all of the grant-funded recipients to say, ‘Do you need to repurpose?’ or, ‘What are your struggles?’ That’s allowed groups to be able to react to COVID with existing funding that they’d already allocated.

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Some saw opportunities for creativity in online formats where people ‘battered out different ideas’ (A5-RPM-15-P3-W2). Here, a resident partnership member describes how they adapted a planned activity to work virtually:

Let’s think of a way of doing it during COVID. So now it’s all online and it’s like a downloadable PDF pack, there’s a video tutorial and then people have got to send in their submissions to us.

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There was some criticism that these reactions were putting in place lots of short-term projects that might reduce the funding available for longer-term initiatives, as this BL rep noted:

They’ve invested heavily in their food bank, but not in a very sustainable way … it will mean diverting a lot of resources from their other activities to one or two key activities …. It could be that it shortens the life of Big Local, because money will be going through faster.

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However, there was evidence that these COVID-19 responses were generating increased knowledge among BL partnership members about local needs and problems of inequality in the community. As one BL rep put it, ‘COVID has sharpened their awareness of what they already knew’ (A5-Rep-P3-W2). And, as this resident partnership member illustrates, some understood that these issues required a long-term approach:

We found out through COVID that people do need these things now through COVID, and after COVID when we’ve finished here … they will still have some support.

A13-RPM-2-P3-W2

Readiness to respond and ability to adapt

The readiness of BL partnerships to respond to COVID-19 and their ability to adapt were influenced by many factors, but the extent to which they had developed collective capabilities prior to the pandemic appeared to be important, as this BL rep highlighted:

Everything stopped but then we used this as a base for what we did. Our background from Big Local helped us form this coronavirus response straight away.

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Observations showed that prior to and during the early stages of the pandemic, this partnership remained fairly stable as a group and was well supported by the LTO, with the same chair leading, although many of the actions fell to a few active members. The partnership had invested around half of their budget into the building of a new community centre, which it was suggested had contributed to greater social connectivity and a sense of pride in place, and enabled them to mobilise and provide a direct response.

In another area, the BL rep described how BL partnership members had been through a tense period prior, but were strong enough to draw a line under the dispute, move on and adapt their work to the COVID-19 response:

They seemed to have managed to work through it. And if you attend any of the meetings, you’ll find that they’re still fairly merry … They were very focused, particularly as this coincided with the start of COVID …. It made it all very immediate, I mean important that we were able to carry on, and so people pulled together, I think, on that basis.

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Longitudinal observational data suggest that this partnership was generally well functioning, with committed members and a good relationship with their support workers, who were also considered to be good at their job. Prior to the pandemic, the partnership had been particularly successful with the activities they delivered directly, with support from the paid worker. Success in these endeavours likely contributed to confidence in their ability to respond to COVID-19, with the worker encouraging a radical switch in focus so that the partnership helped deliver a large food bank initiative and additional support to community members.

In some partnerships, success in supporting their local community triggered a positive feedback loop whereby the members grew in confidence through the work they were doing. For example, this BL rep reported that the partnership chair had said:

‘this is the making of us; this is what we’re here for’ … he really ties what happened over COVID with what Big Local is in essence.

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The rep went on to describe how they were also attracting new partnership members and volunteers, while this resident partnership member described how their work in the community was contributing to wider reach within the community.

Through doing the meals, the isolation packs for pensioners, we picked up some more because they didn’t know about it and they get talking.

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Some partnerships that had achieved success in their response to the crisis were also benefiting from improved relationships with partner organisations, as this BL rep noted:

I think their impact has perhaps been bigger, and you know, in a shorter period, and more widely recognised, and valued as a result, and so I think they’ve brokered some more relationships, and some more respect, you know, with councillors, etc.

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Limited readiness

Not all partnerships were in the same position at the start of the pandemic. Some appeared to have not yet developed sufficient ‘power within’ to respond to the COVID-19 crisis. As one LTO representative reflected:

They could have made a decision to really take the bull by the horns as it were, yeah, do things similar to other partnership area, but they didn’t have enough depth in the partnership in my opinion …. I think they made the right decision really because it’s intense, it’s resource intense if you’re leading on something. You know, if they decided to do some kind of food-related project or if they wanted to support digital on a big scale, they would have found that very challenging.

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The LTO rep went on to suggest that the problem was related to the internal dynamics in the partnership: ‘[It] doesn’t feel connected does it? It doesn’t feel like the relationships are there’ (A4-LTO-12-P3-W2). Our longitudinal data reveal that this BL partnership had experienced considerable challenges since the beginning of the programme. They struggled to agree direction and how best to spend the money. There was high turnover in partnership members, and distinct factions among those that remained. In response to COVID-19 restrictions, the partnership struggled to meet online and provided little direct support in the neighbourhood but, as the LTO rep noted:

They put up a good part of £10,000 in emergency funding, which is fair play to them …. So they didn’t completely inject themselves; they put more money into the system and offered more help indirectly via us.

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Existing governance arrangements could also limit BL partnerships’ response. In one area, a BL worker revealed that the partnership’s terms of reference required decisions to be made face-to-face. Proposals were put forward to amend the terms of reference to facilitate online decision-making, but the decision could not be ratified at a face-to-face meeting. Thus, the board were caught in a closed loop, unable to progress:

Our structures aren’t flexible enough; one of the proposals from the residents was that they should be allowed to submit their views by proxy or write it down …. they were told they couldn’t have the proposal ratified or approved because we couldn’t have a meeting.

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The worker had previously described a ‘resistance to change’ among particular partnership members, suggesting that the previous reliance on governance arrangements to manage challenging internal dynamics was ‘extraordinarily frustrating. At the time when we were needed most, we were appearing to do the least’ (A11-BLW-1-P3-W2).

A further factor limiting the ability of partnerships to contribute to the local humanitarian response was not having their own premises from which to operate; in part, this was a reflection of the progress that had been made in delivering BL plans. For example, this LTO rep explained that the partnership:

didn’t have a space, we couldn’t activate like a community hub in response to the COVID-19 like some of the other Big Locals have been doing …. If it had been another 12 months down the line they might have been able to do that. We would be a bit more established with the activities in the Hub.

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The COVID-19 pandemic was also adversely affecting the personal lives of BL partnership members. Reflecting on the recent loss of several partnership members, this BL rep said he ‘would connect all of them leaving to some degree to COVID’ (A5-Rep-P3-W2). Inevitably, this was causing instability and undermining the BL partnership’s power to act.

Social environment pathways

The most prominent pathways to improved health and well-being embedded in residents’ narratives were related to the improvements in the social environment. There were two linked themes: one describing individual benefits, the other collective benefits.

The first pathway led from activities that sought to reduce social isolation and encourage social interaction, leading to improvements in mental health at the personal level. As this resident partnership member explained, some of their activities brought people together and got them talking and making friends. This participation then, in turn, led on to better mental health:

It’s a social thing … so you can come along and you do an activity but you’re also talking to people, relating to people, getting to know people. So, to me it’s the same sort of thing. So, like the choir, it is a social thing as well as an activity … I think people are engaged. I think they feel better.

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There were many descriptions of BL activities that started off with a specific practical purpose but evolved into more general social interaction and support. A self-management course set up by and for people with chronic illness, for instance, led participants on to further activities and friendships. Potentially, as one resident suggested, this could feed back into improvements in people’s living conditions by giving them confidence to do new things in their lives:

Yeah, so we funded a course for people to manage chronic illness and the feedback we got was that this was a massive thing for the people who went, that it had changed how they saw themselves; it changed how they felt; that they were better able to cope with the chronic illness …. Actually, it had been life changing for people …. When you … increase people’s capacity … to cope you give them an opportunity to do other stuff … because they have the resilience that they need to be able to undertake new stuff and for me that’s really powerful.

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The ripple effect of people getting to know each other was a recurring theme, as was the recognition that although the BL activities might not be able to change the wider conditions of life for residents, they had value at the personal level. The sentiments expressed by this resident echo those of others:

For me, the stuff that Big Local does that has a lot of value is actually more of the quieter stuff. For instance, I’m involved in the open-door mental health group that they run there, but Big Local kept going after the funding was pulled by providing Mind with a space to run that group. By connecting with Big Local, I’ve been able to do some volunteering sessions with them … information sessions, using my knowledge as a clinical psychologist for the people in the group, which I think people have found really useful and which wouldn’t have happened if Big Local hadn’t been able to coordinate that. It’s those things, I think, which actually make a difference at ground level, despite what’s happening at a larger, strategic level.

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The second pathway described by residents highlighted improvements operating at the collective level. These activities included bringing people together to fix problems that they identified as important and, in so doing, building trust and helping people get to know each other in their day-to-day lives, which in turn made them feel safer in the neighbourhood and improved community perceptions of well-being:

Big Local bringing people together to fix their own problems … people feel safer, there’s less crime, all that kind of stuff, that contributes to your well-being.

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Many of the residents mentioned the importance of creating friendly social environments, including establishing community hubs/centres, and creating spaces for people to gather and enjoy each other’s company, to create common interest, paying attention to the cultural environment:

I think it was a trigger to get people together. A lot of groups seem to have the same problem whereas (another BL area) for instance they’ve spent all their [BL money] … They bought a run-down old community centre and they done it up so they have a big space to do stuff.

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There were compelling examples of activities aiming to increase social participation/mutual support benefiting a group as well as individuals. For example, this resident partnership member gave the example of a successful group of single mothers supporting each other, facilitated by BL providing space and a creche for their children:

So, there are projects which have benefited people individually and the community, but with minute amounts of [financial] support, almost no support probably … [the success] is off the back of the hard work that the single mothers are putting in, not the hard work that the Local Trusted Organisation is putting in or Big Local.

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Health promotion pathways: less a purpose, more a vehicle to bring community together

There was a category of initiatives in BL areas that, superficially, could be characterised as health promotion: promoting healthier lifestyles, predominantly encouraging people to become more physically active, as a pathway to better health outcomes. On the whole, however, they did not originate with the aim of improving health as such, nor was success judged by BL partnership members in terms of changes in individual lifestyle, but rather in terms of the impact that the initiatives had on wider social relationships in the community.

Many of these activities grew out of a desire to do something for young people in the area, to make them a priority for action. The ideas generated often involved some form of physical activity, such as football clubs, skateboard parks and multisports areas. The motivation was not so much that the youngsters were unfit, but rather that there was little for them in the area and they were neglected and as a consequence just ‘hanging about’ or getting into trouble:

It’s getting the youngsters from doing illegal motorbikes around the estate, it’s getting them off the road and into a trained environment where they’re learning consequences, they’re learning how to maintain the bikes, how to ride safely and … it’s rough riding, which gives them a lot more pleasure …. They know that if they get into problems or into trouble, they’re going to lose that privilege of being able to ride. So, it’s all about consequences and this kind of thing. So that is the project for [this area’s] Big Local. It is the big one.

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Football clubs of one form or another had been set up in several fieldwork areas, in response to the priorities expressed by the local community. Perceptions of impacts of these initiatives were invariably positive, spreading beyond the immediate participants to the effects on families and the wider community. Residents described wider impacts of the football initiatives in terms of camaraderie, involvement, friendliness, participation, and ‘getting everyone together’. Such engagement was seen as a valuable achievement in itself, adding to community well-being:

Well, the football club … it’s probably our biggest success story so far. We’ve got hundreds and hundreds involved, we’ve got teams from like toddler group just having training sessions and then teams for under-sevens all the way up to adult men and I think they did start a women’s team as well …. They’ve got a lot of the teams winning different tournaments, getting top of their like, kind of, leagues, moving up the table and stuff. So, the amount of people we’ve engaged through that project has been phenomenal, really big …. Yeah, yeah. Yeah, they’ve all got their qualifications for coaching, I mean they’re all still volunteers but they’ve all got that and a lot of them have done the referee course and a lot of them are parents to children that are in the teams as well, so it’s just them investing in their children and having time together and yeah, I think it’s been a really all-round good.

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Economic environment pathways

Residents’ accounts highlighted several potential economic pathways to health impacts. Some were centred around enhancing food security, suggesting that tackling food poverty would lead to improved access to food and a more nutritious diet, especially for children from low-income households, which in turn would lead to improved health and development.

A very diverse array of food security initiatives was described, supported by BL and provided by residents. They included breakfast clubs and schemes to provide free midday meals for children in the school holidays, community breakfasts, lunch clubs for older people, help with distribution of donated food from supermarkets, food clubs for people sanctioned under Universal Credit, and community gardens. One user of a food club, for example, who had joined the BL partnership, explained the multiple benefits it had had:

I suppose actually if I hadn’t gone to [X] I wouldn’t have known about the sustainability food project that runs at Food Club … and I now go to that, which has benefited our nutrition and our finances because we have a fixed income. I’ve not got my pension yet. All I have is PIP so we have quite a limited income and by going to the food club we’re eating better than we would perhaps otherwise and I wouldn’t have known about that if it weren’t for X.

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Organisers of food projects for schoolchildren in the six-week summer holidays described the benefits for the children and the positive impact of them as they witnessed first-hand the difference this initiative was making to the local children:

We recognised that we got a lot of kids in the area who are [receiving] free school meals and during the summer holidays they weren’t going to get any. So we set up with a local school chef and six weeks feeding these kids, so we had to give them breakfast and had the YMCA come in and get them doing various activities … then they come back and have lunch … it was such an uplifting thing.

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Some BL initiatives took a direct approach to reducing poverty, supporting people to claim the welfare benefits to which they were entitled and thereby raising their standard of living. Examples of such initiatives provided by resident members of partnerships included the setting up of welfare advice sessions, some in collaboration with the local Citizens Advice; practical advice with filling in forms for Universal Credit offered at a community hub set up by BL; and the formation of credit unions for mutual financial support:

There was another [welfare benefit] one as well, this Universal Credit that people have been struggling with and we talked to people about it and we said, you know, need any help come in. It takes me and [name of another resident] about 2–3 hours to go through it all and it’s hard work for us, but that’s another thing we’ve got on. Any information they want, they can come in here and we’ll put them to right.

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Resident members of BL partnerships also described how they made attempts to respond to the clearly expressed need to do something about the low employment rates in many areas: ‘they need jobs, they need training’ (A3-RPM-5-P3-W1). Boosting employment was seen by some as a way of not only increasing individual incomes and security and hence improving mental health, but also benefiting the local economy and collective perceptions of the area, which would increase overall well-being.

Residents described initiating many work-related schemes, including job clubs, skills updating, support for people to gain heavy goods vehicle (HGV) driving licences and imaginative small grant schemes for start-up businesses, such as hairdressers. However, although these schemes benefited individuals, they struggled to have a wider impact. Indeed, as these quotes illustrate, some of these schemes got into difficulty getting off the ground as economic conditions worsened or national welfare reforms created additional barriers to helping local people and support from public services reduced:

The HGV one’s been really successful. Not obviously on as big a scale as some things that we’ve done, because I think we’ve had about five people pass, but for those people, their families and their lives, that’s made a big difference because they either were not working or were in, like, lower paid employment and now they have a skill that they can use and earn decent money from and it’s been really popular, really popular. We do provide quite a lot of free training courses in all different things and we’ve always had some kind of job club going on in the last couple of years but we’re running it ourselves now, so …

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What we try to do is we give grants to start new businesses, we’ve started three this year and that’s not a lot but it’s three more than there were last year. I think that helps.

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Physical environment pathways

Though there were many references to BL initiatives that aimed to improve the physical environment, the impacts identified were often envisaged as essentially involving a social environment pathway to enhanced health and well-being. So, for example, residents on BL partnerships explained the rationale for improving street lighting in terms of people being able to walk the streets and take exercise safely; community walks and pocket parks were seen as helping people to socialise as well as engage in physical activity; community transport schemes were perceived as encouraging social inclusion and befriending; and the provision of music and arts facilities was described as ‘feeding the soul’.

Talking about a community transport scheme, for example, this resident explained how the driver of the bus bought by the BL scheme saw one of her important roles as to be a befriending service for her older, socially isolated passengers. The BL partnership took this idea further and saw other opportunities to make the most of their vehicle, and now offer a diabetes transport service for people who have difficulty accessing services locally:

[X] is our driver and she does befriending stuff, so the bus itself was always a plinth; it was always a way of getting somewhere that we could go and branch out and offer loads of more things … the NHS doesn’t provide the diabetes transport service as far as I’m aware locally. So we have invented a transport service for befriending and elderly, so over-60s and over-70s and stuff like that, but we … have got a diabetes group that have difficulty getting around and stuff and they’ve got difficulty accessing buses so we brought the bus to them.

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A distinctly different rationale for some BL initiatives on the physical environment aimed to improve the aesthetics of the local area. One line of reasoning was that pleasing surroundings and opportunities to interact with nature improve the way people think about themselves, their neighbours and the area as ‘a better place to live’. Many residents commented favourably on the impact of even small-scale schemes to brighten up streets with flower planters:

Yeah, they’ve got more pride in the area then, yeah. Also, I remember when we were planting one of the planters down the road, this man and he said he couldn’t get out, he couldn’t walk very far but he could walk up to the planters and see them and he said he quite enjoyed it, which was nice, you know, someone coming up and appreciating what you were doing.

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Other partnerships, however, had found it difficult to implement schemes such as window boxes on balconies, where outside contractors had been commissioned to carry out the installation and there was little or no sign of what they had done. Tree-planting schemes also did not always pan out as hoped, running into difficulties with vandalism and ASB. Some BL partnerships were working with local councils to find a way round these setbacks:

We’ve had 420 trees delivered to plant … there was originally a tree line up the hill, and there’s been big gaps occurred. So we were going to fill in the gaps with some of these trees. But because of the antisocial behaviour I was concerned that those trees aren’t going to last very long, because three apple trees we planted as start of an orchard, didn’t last very long. They were broken off, so I was concerned that these trees would have the same sort of treatment. We had a meeting with the council last Friday … and they said the same thing that we do. So they’ve had suggestions that we plant throughout the area down along the school precincts and other areas like that. So that’s what we’re looking at now.

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Reducing place-based stigma pathways

Residents’ accounts highlighted a final, more intangible, place-based pathway to health impacts, relatively neglected in public health policy and practice. This pathway operated through an area’s reputation and the stigma that might have become associated with it over the years. As a PBI, BL has the potential to alleviate stigma through action to improve social, physical and economic conditions in areas, as well as by promoting more positive portrayals of areas and residents living in these areas. Conversely, as a targeted initiative, the programme could conceivably risk stigmatising areas in receipt of funding as well.

Our findings suggest that while there may have been an initial risk when the programme was launched that it would create or exacerbate place stigma, there is less evidence of this affecting BL residents and areas negatively over time. For example, our earlier research in phase 2 of CiC on coverage of BL in the media found that more negative coverage mainly featured around the time when the initiative was launched. 88 While coverage typically presented BL as a positive development, this coverage sometimes dwelled on why areas were targeted for funding, citing areas as ‘needy’ or ‘deprived’. Largely, however, more negative associations of targeting were balanced through a focus in the programme that promoted a more positive emphasis (e.g. making areas even better places to live) and that emphasised the assets of the area and the residents living there.

Over time, our findings also suggest that resident-led partnerships have aspired to regenerate a vibrant identity for their area, and in some localities have actively promoted good news stories in local media, challenging negative external perceptions of neighbourhoods. 88 Some BL initiatives aimed to improve the aesthetics of the neighbourhood partly to reduce stigma. As this resident partnership member described, while they cannot say for sure that this strategy will definitely improve the area’s reputation, they are optimistic about the reaction so far:

Yeah, definitely, and even the things [like] the Christmas event … make us become quite renowned and I don’t know whether it will kind of make people think more fondly of [A14] but it’s definitely going to give people good things to say about the area, like they’ve put on a good event and they have good services. … So, might kind of encourage people to find when they’re looking for their place to live, whether that be private rented, social rent or purchasing, you know, these things that we’re working on that would hit the scales in [A14]’s favour and people will be investing in the area.

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The resident-led ethos of BL has also led to greater visibility of residents participating in civic activity, helping to challenge portrayals of communities as being disengaged or lacking pride in where they live. By improving a sense of pride in the area, this may have also contributed to improving residents’ internal perceptions and attachment to their neighbourhood. Some BL resident partnership members talked enthusiastically about their desire to create more of a buzz about the place by holding events that people want to get involved with and talk about. As this resident explained, these events were intended to make residents feel better about the area as a place to live, but potentially also to shift the outside narrative towards a more positive idea of the place:

Yes, and a sense of hopefulness about the area … I think there’s a wider reputation of [A2] being quite a depleted place. For instance, where I used to work, I’d talk about going into [A2] to meet people and people in the office would say, ‘Oh, but you’re never getting out of there. Everyone moves so slowly. There’s no sense of urgency there at all,’ like, ‘You’ve got e-mail in [A2]?’ So it’s really got a reputation as being somewhere with almost no excitement and oomph to it … Sometimes, I do get the sense that people don’t have an awful lot of hope about what could be achieved. So I do think there’s something about Big Local bringing that in general and that that does, maybe, have a significant impact on those feelings of well-being because there’s plenty of life.

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Partnership dynamics

The complex dynamics in BL partnerships were described earlier. These clearly changed over time, but the conflicts and tensions that emerged could cause visible distress during meetings. These tensions could be episodic or ongoing. As one resident partnership member noted: ‘As far as the relationships within the partnership are concerned, I think some of them are quite strained …’ (A10-RPM-7- P1-W2). However, as the quotes below illustrate, while ongoing conflict could have significant negative effects, BL partnerships could develop the competencies required to work through very difficult interpersonal dynamics:

The negative was when the board was divided …. Just grinding me down, yeah. It was just like the same thing over and over; the same argument, and it was, like, draining.

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Some people want to be dictating to us … and if you say anything, you’re wrong. And I feel that you can’t say what you want to say, because you know, they don’t like it and then it’s all hell to lose. But, yeah, sometimes I go to the meetings and I sit there and think to myself, what am I doing here? I’m wasting my time here.

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It’s a lot less fractious, isn’t it. It’s not stomach churning on a Monday when you’ve got to get ready to go to the meeting …

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The burden of responsibilities

As time passed and BL areas progressed, tasks and responsibilities changed, and the sense of obligation could become more burdensome for some residents:

We have become more structured in … what we are trying to achieve. But that has brought with it more work … this is an anxiety for me, we haven’t really got the Environment and Play theme off the ground properly yet, and that is partly because I have been extremely busy … I feel a bit of an obligation to lead … I have got some expertise in leading things … other people haven’t and so I kind of feel a bit of an obligation to the group.

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As residents became more invested in BL and embedded in the initiative, they could feel somewhat trapped in their roles in what was often a small core group. These residents reflected on their experience:

It created a lot of stress but to a large extent you could say I could just walk away, and that stress would go, except I could never just walk away.

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I felt invested in them as a group. I felt like I was maybe letting them down because they didn’t have people to do things and so to lose a person … I felt, I just felt bad about it.

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The burden of responsibility as a resident member of the BL partnership could be exacerbated when on occasion it was necessary for them to take on things that they had no experience of, or training in. They often felt an obligation to do this, but it could require more commitment than they anticipated. The longer they had been involved in the partnership, it seemed, the greater their sense of obligation:

That month that he [paid worker] was off was very, very hard – very, very hard … because it was myself and [BL worker] morning and evening really propping her up … because she was still learning … I didn’t expect to do being a volunteer, is managing all this HR … it was too much … for me … to put that level of commitment in and that level of worry and thoughts and pretty much pulling things along.

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In some BL areas, the employment of staff meant more rather than fewer responsibilities for resident partnership members, sometimes without systems and human resources at hand to provide guidance and support. There were examples of problems or particular needs arising with paid staff that residents were not equipped to manage, a situation described vividly here:

I went through a period about 18 months ago where I was kind of completely frazzled by the whole thing … as the partnerships mature, they take on more responsibility and one of the areas where we took on that responsibility was employing people … So we were dealing with those two people with very complicated health issues, yet as a partnership board we had no legal constitution; we had no [human resources] procedures to speak of; we delegated all of that to [name] and that caused a lot of kind of strain.

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This resident went on to describe the impact on him of an ‘exit conversation’ with one employee with cancer who had been undergoing treatment and was under enormous pressure:

His reflection was that we were completely incapable and unequipped to deal with that well for him …. I went through quite a long time of kind of beating myself up about that, really, and thinking … have we made the situation worse?

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The burdens of volunteering

The challenges of being a volunteer member of the BL partnership were commonly described as burdensome and stressful, often in the context of ‘too few people’ being actively involved: ‘I do wonder … I’ve been saying “how do we get more people involved to take the stress off?”’ (A14-Stakeholder-P2-W1). For some resident partnership members in paid employment, the stress of making time to volunteer and feeling obliged to continue in key roles was exacerbated when they were criticised by others on the partnership. As one vice chair resident noted:

Where you’ve only got a couple of key people doing a lot of work, you expect people’s sympathy or empathy … and people are having to fit it around full-time work, but you don’t get that, it’s like, oh why hasn’t this been done … there needs to be like more understanding.

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There were other examples of residents feeling frustrated by being underappreciated. One resident (heading a communications subgroup) who had been enthusiastic during the interview in phase 1 of the CiC study in 2014 had left the partnership a year later. In her interview after she left, she used the metaphor of a minefield to explain how difficult it was when her expertise and knowledge were ignored and others with no experience dominated discussions and decisions:

I thought they wanted someone with my skills and expertise … [and say] ‘We’ve got an expert here, let’s work with this expert to achieve an objective’ … on paper I’m responsible but in reality, I’ve got people walking all over this minefield and it’s blowing up in my face … I couldn’t stand the frustration … It was like … I can devote my time to this, or I can pull out before it gets too traumatic … So that was it.

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The stress and anxiety of voluntary membership of BL partnerships and the relentless nature of the responsibilities could also spill over into everyday life:

I get frustrated sometimes because we’re retired and I have never worked so hard in all my life. It consumes us many times seven days a week and there’s no turn off, it doesn’t stop … it never stops. We get home and it’s hitting us in our e-mails, on Facebook, on everywhere, it’s just constant. So it is tiring at times.

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My quality of life [sighs] … I do get very stressed out with it sometimes. The frustration that it’s not being, the money’s not being spent properly frustrates me terrible.

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Some residents also described how the voluntary work for the BL partnership encroached on their employment. While this was fine in the short term, when combined with the tensions and conflicts of partnership dynamics it could become too burdensome and lead to residents resigning. For this resident, trying to deal with conflict on the partnership and the obligations of daily life proved too much:

I’ve stepped back … there were bitter conflicts … my sister, although we work very closely together, I felt like I was arguing with her and I thought I’m not falling out with my sister over it. I was working full time, overseeing that, applying for grants and trying to get on top of it. It was getting a bit overpowering and I was short-tempered … when I thought I was going to lose my sister over it, that were it … I’m fed up with arguing and I weren’t going to fall out, that was it. It is stressful – my husband, he got a few ear bashings …. The upsetting part was that’s cost a friendship.

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Organising large-scale events could be particularly stressful. This resident, organising an event they felt was not a success, in the context of an already overstretched daily life with caring responsibilities, decided to leave the partnership:

The gala I found very stressful this year because it were down to me to organise it all. It didn’t turn out … then you just think … all this hassle; you’ve got your mum and dad who are getting older and poorly. Two sisters who are disabled. So, your family comes first. That’s why … what I said is I’ll step back.

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And this resident member of a different partnership expressed similar sentiments:

It can be quite stressful … organising events, there’s always something that will go wrong at the last minute, no matter what you do! … And obviously I have a job, I have a family, so trying to organise events and projects, time restraints is an issue.

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The pressure of leadership

The difficulties associated with problematic internal dynamics in partnerships could be amplified for those with particular governance responsibility. As this partnership chair commented: ‘I wouldn’t wish the chair on anybody …. it’s very stressful’ (A14-RPM/Chair2-P2-W1). This chair stayed until the project she was leading had been successfully completed and then left. She was replaced by a resident who had been vice chair, who described how the partnership dynamics had made her role more difficult and extended into her home life:

They’ve kept me as chair … I got attacked by this person, to say, ‘You’ve let the ball slip … You basically have not done what you were supposed to be doing. How dare you?’ … I find that people are quick to attack … That’s one of the things that I struggle with, getting attacked …. As chair you have to be very robust, you have to have a thick skin. [Also] as a chair you never get a thank you … this was affecting my home life, my kids … when you’re a chair they just expect you to get on with it.

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In another area, the new chair described the situation after taking over from the previous chair and the BL rep leaving due to tensions and conflict between partnership members:

Things have been hard … the dynamics of the group … ‘chaos and the mess’ … It’s walking a minefield, trying to get the balance … It’s a matter of spinning plates – being chair – working out how to move forward and out of the chaos … People dynamics are a huge issue. We need resilience. It’s much harder than I thought it would be.

A10-RPM2-Chair-P2-W2

The experience of a vice chair in yet another area illustrates the enormous burden large projects can create for residents who agree to lead them. This project involved drawn-out negotiations over a lease for a community hub. Observational notes (A14-P2-W1) reveal how the vice chair was repeatedly verbally attacked by other partnership members, including the chair, and was visibly distressed. The impact was commented upon by others at interview: ‘The vice chair … is really down at the moment and he was going to give it all up, he … is on a knife edge’ (A14-RPM-1-P2-W1). The BL rep reaffirmed this: ‘The vice chair, who works and has been off sick, he has only just come back this week, and there was stress on him mentally. He was feeling the partnership was difficult’ (A14-Rep1-P2-W1). Similarly, a local stakeholder who attends partnership meetings commented: ‘When I say I hope vice chair isn’t broken by this, I fear that the kind of stresses and the strain he’s been under could actually do him harm … he’s having a really hard time’ (A14-Stakeholder-P2-W1).

The vice chair subsequently left the partnership, and in his last interview in 2019 he reflected on his experiences:

Yeah, it’s been very much up and down … I was … diagnosed with depression before I got involved with Big Local … I didn’t know whether the work that I was doing in Big Local was making me more depressed … not being well in my mind because I was trying to deal with things that I hadn’t dealt with before and was in situations which I had no knowledge of and you know how that makes you feel in terms of maybe feeling a bit inadequate.

A14-RPM4-P3-W1

While some resident members of BL partnerships decided to resign, others ‘stepped back’ as a temporary respite – sometimes on multiple occasions, as this resident partnership member highlights:

You can definitely get burnt out. The resident who runs [name of project], we’ve worked together for a very long time now since the beginning. She’s burnt out several times; she has had to step away for a few months. I have burnt out once or maybe twice now.

A14-RPM5-P3-W1

However, alongside their reports of significant negative impacts, some residents also described positive benefits from their involvement in BL. The vice chair in A14, who felt that BL had triggered his depression, also noted that without his experience in BL he may well not have decided to enrol in higher education. Similarly, this resident partnership member noted that she had learnt a lot from her negative experience:

I’m feeling better having kind of taken a step back from everything, was involved for about five years … it gets to a point where … it’s not easy any more … More than likely Big Local did affect my health in a negative way but I don’t blame Big Local for that. If anything, I am happy that it happened because I am now more self-aware about … what triggers my kind of bad days and a bit more aware on what I can take on and I feel a bit happier with kind of like saying no to certain things. It’s kind of like I’ve taken a step back from lots of different things and then at the time they may have affected my mental health negatively but I’m also glad that I was a part of them.

A14-RPM4-P3-W1

Pursuing improvements in a hostile context

In assessing the potential social and health impacts of BL, it is important to remember that the programme was implemented from 2010, the beginning of a decade of unprecedented cuts in public sector finances. These cuts have been shown to have been deepest in the most disadvantaged areas of the country and to have resulted in the devastation of many local public services. 135–137 Additionally, by the end of 2018, all parts of the UK had introduced Universal Credit for unemployed and economically inactive people, which has had negative mental health impacts on those in receipt of this benefit. 138,139 These policies are likely to have created a disempowering environment, particularly for populations in the relatively disadvantaged areas in which BL was implemented. The often extraordinary commitment residents made to deliver improvements in their areas, utilising the opportunities afforded by BL, are all the more impressive when seen against this hostile backdrop of worsening economic conditions, cuts to public services and restricted eligibility for welfare benefits. This was a recurrent theme in the account of the BL experience given by residents and by local and national stakeholders. The impact of these policies on communities has also been referenced in research commissioned by LT. 102 As the programme moved into the later stages, BL residents also had to face the challenges imposed by the COVID-19 pandemic (see Chapter 7) which, like austerity, have hit the most disadvantaged neighbourhoods of England the hardest. 115,140,141

Big Local’s impact on residents’ capabilities for collective control over decisions and actions

Big Local’s impacts on social and health outcomes

The CiC study has sought to assess the impact on health and well-being outcomes and their social determinants at two levels – among the populations of BL areas and among the residents most active in the programme – and both quantitatively and qualitatively. The quantitative research on the impact on active residents utilised data from the LT survey of partnership members only. In earlier phases of CiC, the qualitative research included residents engaged in a range of BL-sponsored activities, but in the third phase, resource constraints meant residents’ interviews were restricted to members of the BL partnerships. CiC has also explored the possible pathways to health and well-being impacts identified.

The economics of Big Local

Our evaluation of the economic impact of BL (see Chapter 9) involved a cost–benefit analysis, not a cost–effectiveness analysis. As noted earlier, the latter requires a single measure of ‘effect’ such as the QALY typically used in evaluating health care and medical interventions. Instead, we used the life satisfaction approach to value the benefits of BL, this approach involves findings from BL residents’ responses to the question ‘Overall, how satisfied are you with your life nowadays?’. The costs of the programme included the funds each BL area received, as well as the value of the time residents and other people have given to BL. Our benefit estimates might seem very large. The reason is that a small difference at the individual level becomes a large difference at the aggregate level. On average, we estimated that the 0.01 increase in life satisfaction on the 0–10 scale is equivalent to an income increase of £234. Once we apply this small increase to the whole BL population of approximately 1.1 million, we get to an aggregate value of approximately £260M per year. We realise that this figure is the best-case scenario. We also acknowledge that the original life satisfaction finding was not statistically significant in conventional terms. We therefore undertook an extensive sensitivity analysis. In summary, though there is much uncertainty around the estimates, the overall net benefit of BL was positive in nearly all of our scenarios. Our most conservative net benefit estimate is £64M. This estimate translates to a 30% rate of return on the original National Lottery grant of £196,873,499.

Resident partnership member SW2-RPM-5

I had a conflict but now there’s a lot of people stepped back and we’ve sort of empowered ourselves … going to meetings … running stuff on our own without anyone telling us how to do it. It’s incredible, it feels great. … You can definitely get burnt out … I have burnt out once or maybe twice now but at the same time it’s like it’s incredibly, I don’t know

SW2-RPM-5-P3-W1

This resident partnership member was interviewed repeatedly over several years, phases 2–3, and four waves of interviews. This is a male in his late 20s with self-reported diagnosed health conditions which impact his interaction with others. He is a resident. He is unemployed, is a relative newcomer to the area (moved here before BL) and displays great enthusiasm for equality, community empowerment, and the BL initiative and is actively working to make the area a better place to live for residents, through his role and the green projects he drives/is involved in. This involves collaborating with external organisations (school, council) which he describes as confidence and skill building to better equip him with skills. As a key and very active resident, his confidence has grown over time, and he describes his new/developing capacity to talk and liaise with professionals and learn skills as a new way of being. He is reflective of the new spaces he acts in and how he is required to, and does, change his behaviour. Part of his changing self-perception is the way he describes being perceived by others. More recently (phase 3), he has been given the opportunity to work, in a formal setting and capacity, alongside his volunteer role for BL. He describes how this gives him a sense of self and purpose, and confidence that he is perceived differently as not just a volunteer. It is this ‘through the eyes of others’, which is confidence building. He describes being empowered, changing his behaviour and learning the skills to be in formal spaces. This is through his paid role, his projects and how he develops them for community participation. There have been times when his health conditions have manifested, and he has stepped back, but these appear to have been brief. The main BL partnership support worker emphasised how there is a need to support residents who take part in BL and similar interventions, in terms of their mental health, and the need for herself and the partnership members, staff and residents to be supportive of those with mental health diagnoses or conditions, which may be exacerbated by the stresses of being a partnership member.

Resident partnership member L2-RPM-5

I’m not stressed out anymore. It was the first thing I had ever volunteered for in a community and I will not volunteer for any community activity ever again.

L2-RPM-5

A resident for 20 years and retired teacher, this member was interviewed three times between 2016 and 2020 (along with her partner). She initially described negative aspects: ‘it’s quite difficult to pin anybody down on doing anything’. Partnership dynamics had been difficult for 2 years before they started pulling together. She described personal benefits of networking and being more connected in the community (2016). By 2018, there had been more problems, and she reflected how the partnership had come through fractious times; but now, she no longer dreaded meetings: ‘There’s no chairs being hurled across the room any more … it was really horrible’. Also, volunteering was time-consuming, especially with ongoing conflicts being a constant within the partnership. She felt worried and had endured sleepless nights. She then had sciatica, hip surgery and bereavements and was left feeling low. She stepped back from BL for a few months. By 2020 she had been voted off the partnership; things had become heated. She had been shouted at in a meeting, felt threatened and communicated a sense of injustice, describing a ‘kangaroo court’. Her experience had been negative, exacerbated by a lack of support from LT. Overall, it has been ‘a nightmare …. I feel a lot better now I’m not going.’

Resident partnership member SW1-RPM-1

I suppose in the end that [the second episode of major conflict on the partnership] give me the opportunity of resigning, all this what’s blown up. So I got out. No more. Not running around after every Tom, Dick and Harry any more. I’m 71, I’m retired; I shouldn’t be belting around like that. I enjoy doing it, don’t get me wrong, I enjoy doing it a lot. It gives me something to do, kept me occupied.

SW1-RPM-11-P3-W1

Interviewed repeatedly over several years, this member is a white working-class manual worker and a resident partnership member. Retired, he lived alone and had recently moved to the area at the start of BL. He lived very close to the BL hub, where activities and meetings are held and staff are based. He was embedded in the BL structure and network in a range of ways. Over time, he expressed enthusiasm about BL and the meaning it held for him. He regularly attended meetings, volunteered alongside paid workers, met with council officials and acted in a ‘caretaker role’ for the hub building. This gave him a social network, daily life structure, community responsibility and visibility. He occupied a significant role in the partnership and among residents in the wider community, who used the hub for regular activities and events. He expressed at the interview how this was positive for his mental health and well-being, as he described it explicitly as ‘meaningful occupation’ which provided him with a network of relationships within the partnership and looser networks in the wider community. Over time, he was impacted by the tensions in and subsequent restructuring of the partnership. Although during this period he described being unhappy with these issues, which he found stressful, he remained supportive of BL and continued in his pivotal role, and the stressful episode and its impact on him subsided. When the cycle repeated itself, however, with more conflict and tension with a new group of key partnership residents and staff, he was unable to continue as a partnership member. He described the cumulative impact of the sequential tensions and conflict, which was significant enough for him to give up his valued role when on balance, the experience had become negative and outweighed the positive well-being benefits felt earlier on in the initiative. This was diluted by his tendency to still attend the hub and meetings but to distance himself from any key role.

SW1-RPM-4

Sometimes I’ve been depressed … feel a bit down and then pull myself up again. But apart from that no; I can see a future … I can see things ahead for these teenagers … They are our tomorrow.

SW1-RPM-4-P3-W1

RPM4 was interviewed three times across phases 2–3 (2016–20). She is female, resident for 52 years, 72 years old, well known and active in her subarea of BL, with a paid role in a community organisation, running its community centre which pre-dated BL. She was vice chair of BL in 2016 and chair by 2017, leaving by 2020 to focus on her community organisation role. She had intended to resign earlier due to partnership dynamics: ‘I had lost my confidence … I didn’t think I was in control …’ Partnership members were at ‘loggerheads’ and she felt ‘I just can’t hack it any more’. She also described limited teamwork and ongoing challenges with LTO workers, one of whom tried to dominate. However, she remained as chair due to partnership requests. Over time, things improved: ‘It’s going great; I am going places and I’m seeing people … teamwork is working.’ In her last interview, she described continued issues with LTO … but she would ‘not be manipulated’ and would ‘take the flak’. In her third interview, she reflected ‘I’m a fighter … if it stressed me out, I’ve still fought through it … It’s a hard job.’ But she felt it was a ‘satisfying job’ due to the differences they had made and her increased confidence.