It is early evening at a crossroads on a rundown housing estate in the heart of the east end of Newcastle. At each corner of the junction is a patch of grass, each with the stump of a decorative sapling snapped just above its supporting post. Kids jump on a trampoline in a nearby garden, bike frames sit rusting in the long grass of another.
Around the corner come three bikes, two with trailers on the back. The first trailer is carrying a pottery wheel and the second a kitchen with a workbench, sink and hob. The cyclists stop their bikes and trailers on a patch of grass at the junction and start setting up. A boy cycles past, he exchanges a few words with one of the cyclists, then cycles off. Two minutes later the boy returns with three friends. Soon they are mixing pancake batter and making a pot. Other children come over and join in. Within 10 minutes, 15 children are milling around the Kids Kabin street workshops.
Compare this to the smoking cessation course run in the local community centre. The community centre is working with the Primary Care Trust. Two health advice workers sit next to a pile of glossy folders full of the most up-to-date brochures, information, and self-help advice about stopping smoking. Outside in the community 30 per cent of adults smoke and evidence suggests that more than half of these smokers are keen to give up. Everything is well planned and set up for a successful course.
Where are the people?
But there is one big problem. This is the sixth week of a ten-week course and so far, only two people have walked through the door, and each of them only stayed for one week.
Many such services are not being used to anything like their full capacity. We might assume that this was only the case for large “inflexible” public sector services, and would not happen within the voluntary sector, heralded by many as the “third way” and able to take advantage of the innovative and dynamic nature of small organisations. But similar stories of limited participation are mirrored across the board - at family learning sessions at primary schools, community arts initiatives, in community centres and art clubs.
The pattern can even be found with some universal services such as GPs. Dr Tony Thick, who practises in Cowgate, an area of deprivation in the west end of Newcastle, says “people from deprived areas seem to find it difficult to go into ‘official’ buildings”.
At a time of pressure on budgets, cuts in services and an acceptance of the increasing inequality between rich and poor, it is more important than ever that the services which do survive are effective and efficient and engage the people most in need.
So why are people not making the best use of available services? Let’s look at the example of the quitting smoking course. Is it a problem of accessibility? The building has full disabled access and is based in the middle of the target community. Is it a lack of information? Posters have been put up in local shops, GP surgeries and other community venues. While they wait, the health workers look out of the window and suggest some other reasons for the lack of participation. “The weather’s awful” or “It’s raining and people are staying in” or “People like doing their shopping on Tuesday mornings.”
When local residents were asked why they did not take part, answers ranged from “I had to look after the children” to “I had to go to hospital” and “I had to go and do my shopping”.
Fear of the unknown
All these reasons are certainly important. But there seems to be another significant factor that is rarely acknowledged: a psychological barrier created by the building itself. In the case of the community centre, people smoke, want to give up and know about the service. However, they have real trouble “stepping over the threshold”. They have a fear of the unknown inside the building. This fear seems particularly significant for people living in areas of deprivation where “official” buildings are seen in a particularly negative way. People who live in such areas have often had bad experiences of school (where they failed academically) or negative experience of other professionals in official buildings (such as visits to police stations or the benefits office).
So how can these barriers be overcome? The two people who did attend the course in the community centre offer one clue to a solution. They went because they already knew one of the workers. It seems that a trusting relationship could be an essential factor. But how can such relationships be developed with the people who find it difficult to enter buildings?
This is why some organisations and individuals are starting to “think outside the building”. Dr Thick’s response has been to run “street surgeries”. A health centre opened in Cowgate in October 2009 and Dr Thick wanted to find a way of meeting local residents and of raising their awareness of the services available. He decided to move out of his surgery and on to the streets, meeting people and offering advice.
By stepping outside the building and on to the streets, the doctor changed the power relationship, putting himself in a less powerful position just by being outside the surgery, with its administration desk, waiting room and offices. The resident is more powerful on the street; they are on their own turf.
Newcastle-based children's charity Kids Kabin has taken this street approach a step further, taking workshops out of buildings altogether and down the streets where children live and play. The charity runs daily arts and crafts activities using a fleet of trailer workshops - a mobile kitchen, a potter’s wheel, a bike repair workshop and a wood carving trailer - all pulled by bicycle. A local resident has commented that this attracts kids “like bees around a honey pot”. When the children join in, they are soon followed by interested parents and residents. The Kids Kabin staff team reckon they can talk for longer and to more parents during one street workshop than they would in one fortnight of building-based activities.
Kids Kabin, Dr Thick, and Newcastle are part of a wider movement of people and organisations “thinking outside the building”. The international anti-poverty charity ATD Fourth World has run street libraries in many countries over the past 20 years. Their teams take books into the streets and turn the pavement into a library to engage families of children who may not even attend school and would therefore have little access to books.
This is just one of a growing numbers of examples of people thinking “outside the building”, thus removing barriers and building new relationships. Meanwhile, the majority of health, informal education and other community services resolutely remain in offices and buildings as they always have, waiting for people to come to them.
We are in an age of austerity that seems likely to continue into the medium-term. In such an environment, effective services must be targeted at those people who most need them. That means organisations finding ways to overcome barriers.
The biggest barrier might well be the building they are sitting in.
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