The right tool for the task: 'boundary spanners' in a partnership approach to tackle fuel poverty in rural Northern Ireland.

To date, research on fuel poverty has largely focused on the outcomes of interventions, with little attention being accorded to intervention processes. In reporting on an evaluation of a fuel poverty intervention in rural Northern Ireland, the present authors explore some of the mechanisms that secured the project's perceived success. Specifically, they focus on the role of the 'boundary spanner', a concept that is increasingly applied to the analysis of local health partnerships. Initiated by a health action zone (HAZ), the project was implemented by a partnership of 21 organisations from the statutory, community and voluntary sectors. The role of the HAZ manager was described as ensuring that partners stayed engaged, that the project secured support from organisations and that it impacted on policy-makers. A full-time community energy advisor carried responsibility for the partnership's communication with the recipient communities. She worked closely with community associations and project recipients. The project was consistently described by stakeholders as community-led and as having been very successful. The authors suggest that this was because of the roles of two individuals who, at different levels, communicated and negotiated with partners and recipients, maintained momentum, and facilitated the ongoing involvement of the communities. The literature on boundary spanners usually focuses on how the role enables organisations from a range of sectors to participate in partnerships and tackle issues outside the remit of single organisations. As such, it usually describes spanning boundaries 'across and upwards'. While such insight is important and valuable, this study shows that a fuller understanding of the success or failure of local partnership interventions can be gained by also exploring the process of spanning 'downwards'. The authors conclude that, by extending the concept of the boundary spanner to include spanning 'downwards', the concept's explanatory power is enhanced.

Standardized health check data from community-dwelling elderly people: the potential for comparing populations and estimating need.

The main aim of this study was to compare EASY-Care data obtained during nurse-administered annual health checks in two populations of older people. A secondary aim was to determine whether a standardized assessment system administered as part of routine practice by a trained nurse during the over-75 health check could generate useful information for comparing population health and functional status of community-dwelling-older people. One hundred and seventy-nine elderly people (aged 75 years and over) from the Woodstock ward, Belfast, having relatively high deprivation; and 238 elderly people from south Hampshire, ranging from affluent wards in New Forest to inner city wards, were assessed using the EASY-Care assessment system as part of their annual health check. There was a high response rate to the standardized assessment in both populations (75% and 79%). Compared to people in south Hampshire, the people in Belfast had higher relative risk of having fair/poor self-rated health, and lower relative risk of having good/sufficient accommodation and of having difficulty chewing. People in Belfast had a higher relative risk of being dependent for six of the seven IADL items and for continence of urine, bathing, grooming, use of the stairs and dressing among the ADL items. The results demonstrate the ability of data generated by assessment system to discriminate between populations of older people when used as part of routine practice. Differences in health and functional status may be associated with deprivation. Data collected during the annual health check about the health and functional status of older people could provide a useful adjunct to census and survey data to measure population needs and to support locality planning.