Learning from 10 Years of Poverty Proofing© by Children North East

 

At Children North East’s recent conference celebrating ten years of our cutting-edge Poverty Proofing© work, we heard from leaders from health, culture and education systems describing their journey of change to tackle poverty in their communities.

 

 

The evidence of the links between poverty and poor health outcomes is overwhelming.

We see twice as many incidences of respiratory illnesses for children living in fuel poverty (Institute of Health Equity), the most deprived 10% of children make double the number of A&E visits than the least deprived (The King’s Fund), fewer children living in poverty hit developmental milestones around speech, language, potty training and school readiness (Save the Children). We see soaring childhood obesity (Nuffield Trust), declining dental health (Queen Mary University of London) and an epidemic of mental health issues among children and young people (Mental Health Foundation).

Poor health outcomes continue for a lifetime, and the cost to the public purse is staggering. In diabetes care alone, it is estimated that over £6bn is spent annually on complications that could be prevented with the right care in place. The human cost is worse; hundreds of thousands of children denied the chance to grow up happy, healthy and able to thrive.

Poverty strips families of agency; the ability to plan, to maintain a routine, to make healthy meals, to make and keep appointments, buy the right equipment to meet their children’s basic needs, to budget, to keep their house safe and warm. Under the weight of day-to-day survival, families struggle to act on concerns until things reach crisis point.

The same could be said of public services, which have been surviving on poverty rations for so long. Not being able to invest in more diagnostic equipment that could bring down waiting lists. The regular disruption of patching up buildings no longer fit for purpose. The inability to plan budgets beyond the single year. The lack of capacity to offer routine appointments when they are due. Ever increasing thresholds and the inability to intervene before things reach crisis point.

The intersection is catastrophic for struggling families, who are unable to make appointments with GPs and facing long waits for assessments and treatment, from neuro divergence, to mental health, to surgery for debilitating conditions. Those with the agency and resources can make lifestyle choices to maintain their wellbeing, fight the system to get the care they need or opt for private treatment. Those without continue to find themselves at the bottom of the pile.

It’s clear that we need change.

To address the barriers poverty plays in preventing people accessing the education, opportunity and healthcare they are entitled to, but more than that, to equal up the systems for those using them.

Speakers at our Poverty Proofing Conference discussed how they are bringing their workforces with them on the journey, and how they have looked again at key policies and processes to make inclusion the overriding priority.

Our Poverty Proofing work shows that small changes can have a huge impact. In one health setting, a scheme was set up providing recycled phones to families who couldn’t afford the right technology to monitor their child’s diabetes, ensuring parents already dealing with the health challenges of a child would not have to worry about how they could afford the extra cost of their treatment, or even worse, go without.

Voice is at the heart of the Poverty Proofing model, and using this approach has highlighted dozens of these ‘blind spots’ where assumptions have been made about families having access to resources, or would be able to find the money somehow, just need to ‘budget better’. It also highlights to leaders who don’t think there are issues in their setting the reality people experience. Often this realisation itself is the necessary catalyst for change.

Many specific recommendations made locally, like a recycled phone scheme, are replicable and scalable; what makes a difference in one setting will often make a difference in others.

But other barriers are structural and need change at a higher level. Decision-making about where services are geographically located tied to strategies around maintenance and management of estates. Staff deployment decisions driven by capacity issues. All this affected by infrastructure outside of those systems.

We heard a lot at our conference about transport, the financial cost and complexity of navigating long, multimodal journeys to appointments. As more services are concentrated into larger centres, people have to travel further and the poorest again are the most cut adrift.

We need to bring leaders together to reconsider how services intersect and how they are delivered so we avoid these unintended consequences.

And we can’t ignore the elephant in the room. More and more of our health and social care systems’ resource is being devoured by the ever-growing demands on acute care, growing precisely because people are not getting the healthcare they need at that earlier point. It is the result of a perfect storm of political decision-making, global economic factors, a worldwide pandemic and an ageing population. But it has created a doom loop that needs to be broken before the whole system crumbles.

The Darzi Review makes clear the priority for the health service is to turn the tide on this, getting healthcare back into communities. To make GP appointments accessible in surgeries near where people live, removing the 8am scramble for appointments or the three-week wait, the choice between hoping it clears up by itself or going to A&E.

This, along with a greater prioritisation of prevention and early intervention, is essential to tackling health inequalities and breaking the link between poverty and health.

Investment is part of this, as is direction setting from national government. But the real challenge will be implementing change, and strong, brave leadership at local and regional levels will be critical.

Voices of people using, or struggling to access, services needs to drive change, enabling decision-makers to identify where the systemic issues are, which will be different in each region. Bringing teams along on the journey and making the deliberate but difficult choice to invest proactively in early intervention and prevention work, while all parts of the system are struggling to meet the needs they face in the here and now, are at the heart of the challenge.

The upcoming CPH conference on 27th November 2024 will provide a great opportunity for statutory sector and community leaders to come together to build on this learning and plan meaningful action that can drive real change. At this conference, Children’s North East will be joining other leaders across the country to explore good practice and practical strategies for how to start leading this change. We hope you can join us too.

Originally shared via Centre for Population Health.