Rachel Spencer-Henshall, Strategic Director Corporate Strategy, Commissioning and Public Health, informed the Board that it is the responsibility of the Director for Public Health to produce an annual report, and the 2022/23 annual report, is entitled ‘Poverty Matters’.
The Board was informed that although there has been some reduction in for example, the price of fuel, things are not necessarily getting better for people in terms of food inflation, and the situation with regard to mortgages and rents is getting worse.
Citizens
Advice reported an unprecedented request for support, particularly
from those who had reached crisis point. The findings suggests that even though people were
going to Citizen Advice before this period, people are reaching
crisis quicker and there are more people in crisis and the demand
is becoming greater.
There
have also been reports from Healthwatch, highlighting that people
are avoiding NHS appointments due to the cost of travel, and in
some cases even the cost of phone calls are proving
challenging. In addition, there are
reports of a few people unable to take up prescriptions and
potentially not visiting the dentist.
This creates many things that could have been mitigated in Primary Care through use of prescriptions or access to dentistry, and that might ultimately impact on the system in terms of more people presenting at A&E.
There has been twice as many referrals into food banks through the Welfare and Exchequer Team, and that is only the ones known about within the system, and not what is happening outside of the system. Demand is high for all of those things.
The Board was informed
that lived experience has become a bit of a ‘buzz’ word
in terms of how to describe getting the view of people. It is
however, fundamentally having a conversation with people who are
experiencing this and getting a sense of what it is like for them
to be in poverty.
It is important to thank the 12 people who contributed to this annual report, who were as open as they could possibly be about what they were experiencing, and the report could not have been written without them. They were brutally honest about how it was affecting them day-to day of a life being in poverty. They came from a range of different backgrounds and were in many different situations across the whole Kirklees district.
Many of the individuals had received support via the Local Area Coordination Teams, which is a partnership agenda, run in the council alongside health colleagues and Social Prescribing Link Workers.
The main theme that came out of the report was that people were struggling around household bills and general finances, which resulted in skipping meals, buying food that was out of date and as reduced as possible. Occasionally, this was on the basis of hoping that the produce was going to be all right, knowing there was probably a level of risk, as in some cases it might have gone off.
There was a lot of hope, and sometimes there was a tendency to ignore the positives when thinking about the negatives, and there was a hope that things were going to get better.
Mental
health issues were highlighted as a result of living in poverty,
and people were describing that in different ways. Sometimes it was
about anxiety, sometimes it was about depression, however, mental
health was an important issue.
Travel costs were
highlighted as a barrier to
access to services. It was not necessarily that the services were
not available or open and accessible for people in terms of the
times that were available, it was actually the cost of getting to
the services that was a challenge.
Issues
with housing was raised particularly in respect of relationships
with landlords. For example, in some cases, it was the ability to
afford rent, and the fact that rent was often being increased and
there were dampen mould issues. There has been a number of tragic
cases around the health impacts of damp and mould, which has
highlighted the quality of housing in the district.
Not all the
individuals had the same family circumstances, however, there was a strong will to protect the
children in those families from the impact of poverty. It is hard
to experience something that is causing stress while having to be a
different person in front of your children. The knock on effect for
that was potentially a level of social isolation because for family
members when they were with others and when they were with their
children, they were showcasing that everything was
alright. That puts a huge pressure on
people, and it makes it difficult for them to connect to people and
to ask for support.
There are strong communities in Kirklees, and for some people,
which was the difference between surviving and not surviving, in
terms of the crisis that they were in. It is important to remember
the role of the voluntary and community sector as being pivotal in
supporting people in these crisis situations.
Finally,
work opportunities, and ensuring the right work was out there,
because while there is some work opportunities, it may not
necessarily be the right type, for example, the family friendly
element of work and there are a few recommendations around
that.
The Board was shown a video which articulated the summary of findings and the key themes. The Board was informed that there is a webpage where people can find the full report and it should be reasonably easy to navigate. The webpage gives an outline on why poverty matters and more on the statistics around what poverty does in terms of the data.
It has the national context, and given that the national context changes quite quickly, it will be as up to date as it can be. It also includes the local context which brings in some local data and local intelligence in terms of what is happening around poverty. It includes the case studies articulated, documented as a day in the life, to show an individual’s day to day existence, and how poverty is manifesting itself in some of their choices and actions. There are also case studies from partner organisations. Board members were encouraged to have a look at the webpage and use it within their organisations going forward.
The Board was informed that as part of creating this, a number of community organisations were consulted, particularly the Community Anchors who were fundamental alongside TSL colleagues and others during the pandemic. Case studies were provided from all of those about what they have been experiencing as service providers. This gives a perspective from both the individuals themselves and the organisations that are out there on the front line providing support.
The recommendations were formed based on all the intelligence that came from both the individuals and those organisations, to hopefully get a set of actions to take forward as a Kirklees system.
The following information was given by residents as what would make life easier and how best people can be supported with the cost of living crisis:
- Support with the cost of living - targeted support to mitigate the increases in costs of food, rent, and utilities
- Value lived experience - professionals and decision makers need to gain a deeper understanding of the reality of living in poverty
- Access to services – give more thought to cost issues, (such as travel) in service design and delivery
- Person and Community centred support – prefer face to face support from a consistent and trusted person
- Help into employment – applying for roles, more flexible working opportunities, affordable childcare, and support with costs such as DBS checks
- Free spaces to connect - community spaces to socialise without spending money
- Access to good quality affordable homes – poor quality and precarious housing impacts on people’s physical and mental health, secure tenure is important
There are
a few examples of recommendations, and some are national policy
suggestions, and it is how to take those forward. An important
factor will be putting health equity and wellbeing at the heart of
any kind of planning; and understanding the impact on health and
wellbeing in terms of policy decisions.
For the
health and care system specifically, it is having a commitment to
tackling poverty, and even though many of the wider determinants of
health are more challenging for the health and care system, it
should not preclude taking and seeing action around them. In
addition, looking at inclusive and sustainable economic change,
which links with the economy and economic strategy for Kirklees
going forward. Again, using these views to help to co-design and
develop better communications and better services and championing
that lived experience.
There are a few examples for organisations working in Kirklees, which is much based on the case studies:
- Identify the need for, and promote uptake of, the full range of targeted statutory financial assistance that already exists
- Adjust debt collection processes towards being sensitive to the financial and mental health needs of communities and customers
- Engage and involve communities and the voluntary sector in the assessment of current services/interventions, and the development of new ones
- Consider how to embed support with rising living costs into clinical pathways
- Explore opportunities for developing poverty aware practice in workforces
The Board was informed that for individuals who want help, there is some guidance for frontline staff, for example Third Sector Leaders (TSL). TSL can help around volunteering opportunities for individuals as well as support available for people filling in documentation or just to listen.
Poverty matters, and just doing one thing won’t make it go
away, it is looking as a system at the various influences each
organisation has, to be able to improve things?
The Board is asked to use and disseminate the report and use it
where it is likely to have the most impact.
RESOLVED:
That the Board acknowledges its responsibility to disseminate and use the information.
That Rachel Spencer-Henshall and colleagues be thanked for providing an update on the Director for Public Health Annual Report 2022/23.