We are all suffering from the effects of the Big Dig with the devastation that it has wreaked on the roads of Liverpool. No pain – no gain we hear.

As Merseyside approaches the European Capital of Culture in 2008, we are faced with incredible ‘once in a lifetime’ opportunities.

How about a community involvement in culture that could see, let’s say 10,000 citizens, actively involved in arts and cultural activities? This dream could become a reality and propel Liverpool into the national forefront of culture by intrinsically changing the way decisions are made. I’ve given this the working title The Big ‘Create’.

Little known by the general public, is the fact the modernisation of the health provision in the sub-region includes a capital spend programme that is even bigger and potentially more important than the Paradise Development. The almost £1.1B investment in the renewal of health facilities far outstrips the £800M allocated to retail development in Paradise Street.

Merseyside lags behind the rest of the UK in many health indices, including life expectancy. Why should we accept that we will die nearly 10 years earlier that our colleagues in the South East?

And if you think it is bad for white people, just study the impact on the Black Communities.

Perhaps the answer to health inequalities lies in the approach. The government imposes its health agenda on local communities.

The NHS readily states that it is dedicated to ‘ensure public participation in planning, not least to create a sense of ownership’. It talks of aiming to deliver health care in ‘community settings delivered in a patient-focused and friendly manner’ and its objectives include ‘investment aligned to wider health and social issues of local communities linked to regeneration’.

The Strategic Investment Framework also expresses the view that ‘the physical environment has a direct impact on clinical outcome’.

Let’s review the last era of change. The Royal Liverpool University Hospital was a failure. That hospital has never really been accepted by the citizens of Merseyside! In fact its implementation actually contributed to the disengagement of the local community from health services.

Now it is rumoured that the location for the new Royal Hospital is to be built on the site of the abattoir in Fairfield. Does that demonstrate sensitivity? Do you think that if the community were consulted, they would approve of that site – a site where millions of animals met their death and were slaughtered?

If we examine the attempts by the NHS to engage with local communities they have failed miserably. That is part of the reason why we suffer from such health inequalities in the sub-region.

My plea to you as we move ever more speedily towards the Capital of Culture, is to support the NHS in its ambitious schemes by embarking on a meaningful and achievable community involvement programme based on the arts. But this has to start now, and not after the event when the decisions have been made in the Board rooms. This only leads to retrospective and tokenistic actions.

Imagine if just 1%, a ‘Percent for Arts’, were dedicated to real community involvement and consultation! North Kirklees has set the precedent in terms of LIFT. If Merseyside includes both primary and secondary care investment in facilities redevelopment at say £1.1B that would mean £11M for the arts.

In terms of leverage, why can’t other partners be attracted into this Neighbourhood Renewal and Regeneration agenda? Partners such as the Local Authorities, the Arts Council, the NW Development Agency, the Learning & Skills Council, and Europe could quite easily double that investment.

And what are the key issues?

Firstly: Without proper community consultation the NHS’s attempts to renew the health provision will fail. Local people will rebel against having to walk further to see a doctor or to receive treatment. The local communities throughout Merseyside will not support losing local facilities. The Toxteth Health Council has gone, against the wishes of the local population, and now the NHS are having to spend millions to deal with the resultant health problems particularly in the BME Communities. Just imagine the up roar in Garston, where there is a new Cultural Village devoted to the regeneration of this run down decaying part of the City, when the Alfred Jones Hospital is closed!

Secondly: A real and sustainable involvement in arts and culture will serve as a tangible community engagement programme that will reflect the local community and generate a sense of ownership. I would argue that this would dramatically reduce the opposition to any major changes in health care provision

Thirdly: The new health facilities created will be wonderful settings in which to work and receive treatment. They should reflect the needs of the local community and not just depict a few expensive iconic pieces of art as a sop to real strategic and sustainable involvement.

Fourthly: If the artists (of all genres and styles, painting, sculpture, music, dance etc) are recruited locally, it will help stimulate the local economy. If real principles of diversity are applied it will enhance the quality of work and help tackle social exclusion.

Fifthly: If a 1% of capital spend were pledged by the NHS throughout its entire building programme, this would provide the leverage to bring in other funding. This would double the amount available to the arts and cultural industries. If the LIFT programme is valued at £50m and the Future Healthcare Programme at just over £1b, this would represent £11m from the NHS, matched to a total of £22m. And this is ‘new money’ for the arts during the lead up to the Capital of Culture.

Sixthly: The Legacy? The health gain, well documented and recognised, should not be transient but embedded into the very way the NHS carries out its work. If the ‘percent for arts’ works in capital spend, why not apply the same principle to revenue spend? This would ensure sustainability, would help stimulate the local economy, and will have a beneficial effect on health to reduce some of the inequalities that we endure

Seventhly: This is a once in a lifetime opportunity. As we move towards 2008 and the Capital of Culture, it would be criminal to miss the chance of changing the way the NHS consults nationally. Let’s start putting personal agendas to one side. Let’s find different and better ways to do things that are more inclusive. Let’s achieve The Big Create by attracting 10,000 into this process and really make an impact world wide in terms of health gain, democracy and culture.

Eighthly: Investment in the cultural industries will bring a mass of people together into the process of creating a new, effective and proud NHS for the 21st Century