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As part of an initial needs assessment for a community development project to improve access to health and social care services for new migrants, a local epidemiological profile of new migrants was produced for Walsall in the West Midlands. Data were compiled from Office for National Statistics estimates of international migration, National Insurance Number applications from overseas nationals, ‘Flag 4’ GP registrations by new immigrants, United Kingdom Border Agency asylum bulletins, and Citizens Advice Bureau immigration queries. It is estimated that there has been a steady influx of between 800 and 1,400 new migrants per year into Walsall. The majority are young adults from Asia and Eastern Europe, and are living in the southern part of the borough. This information needs to be updated regularly, shared with relevant partners and used to inform commissioning decisions.

Health inequalities exist between ethnic groups, an important example of this being infant mortality with babies of mothers born in Pakistan having double and babies of mothers born in the Caribbean having 63% higher rates than the national average. West Midlands Ethnic Minority Liaison Committee (WELCOME) and partners organised a conference to arrive at consensus among experts and stakeholders and to make recommendations around reducing infant mortality. One key area discussed, which is often contentious, was cousin marriage: its potential impact on infant and perinatal mortality and what health service response to this should be. Recommendations included: the setting up of a community genetic service in areas with higher risk of recessive disorders as a consequence of cousin marriage; genetic education to the wider public and health professionals; and community engagement, including community and religious leaders. This paper outlines how these recommendations were arrived at, the potential barriers identified in addressing this issue and the process by which service change was achieved with an aim to improve the outcome of infant and perinatal health among groups with higher burdens of genetic disorders in Walsall.

This paper describes a project that moves away from a transactional model of leadership to a shared model of leadership, across health professionals from different organisations, to address health inequalities among deprived black and minority ethnic (BME) communities in Walsall in the West Midlands region of England. Traditional models of leadership can tend to focus on individuals and do not take into account the fact that patient care usually involves a number of staff from several organisations. The project was designed to test the hypotheses that provision of structured support to teams using a shared leadership model would lead to improvements in partnership working and patient outcomes. The project showed significant improvements in partnership working and enabled greater engagement with the BME communities in Walsall. The paper explores the strengths and weakness of the shared leadership model and the challenges in translating the vision into reality.