A surprise jump in inflation landed ahead of a further increase in interest rates last week, making it clear that the cost of living crisis shows no signs of easing soon.
Recent analysis this month by the Resolution Foundation suggested the UK worker’s wage lags about £4,000 a year behind comparable economies such as Germany. The rising cost of living was also the focus of the annual public health report, launched at the joint public health conference held by the Local Government Association and the Association of Directors of Public Health.
According to the report, people’s health is being impacted by the soaring cost of living following on from the COVID pandemic.
It highlighted that those with least financial resilience are affected the most, but increasing numbers of people who were ‘just about managing’ now need support.
It concluded that despite the best efforts of councils in providing support through warm spaces, access to affordable food and more – supported by the voluntary, community and faith sector - there are concerns health inequalities could widen given the scale of the impact.
The report urged government to increase public health funding long term. Another crucial message was that the engagement by Integrated Care Systems (ICSs) with councils and public health is mixed. It said more needed to be done to support ICSs to work with local partners to focus on all aspects of prevention.
What is the impact of the crisis on communities and how are ICSs shaping their policies in response, including mitigating the impact on health inequalities? This was the focus last week of the latest in a series of Health Devolution Commission (HDC) roundtables on key issues facing ICSs.
Former health secretary and Integrated Care Board (ICB) chair Patricia Hewitt’s much-heralded review into how the oversight and governance of ICSs can best allow them to succeed is expected to emerge later this week. It should contain a strong call for cross-government working on prevention and tackling health inequalities.
But ICBs – some at least - are not waiting for support from government – joined up or not – and are already getting stuck in. In its pre-roundtable briefing the HDC set out a number of examples of ICS good practice highlighted by the NHS Confederation. These ranged from tackling food insecurity, reducing fuel poverty, improving mental health, supporting people with learning disabilities, and supporting health and social care workers. For example, Frimley ICS, along with Slough Council and the voluntary, community and social enterprise sector, have opened a number of community pantries and are supporting a meal delivery service so that GPs can refer patients who need emergency help with meals.
The HDC raised a number of key questions, including how ICSs should prioritise action ‘when headlines and politicians primarily focus on waiting lists and waiting times’. There is also the issue of how to work out which of the best practice examples have the greatest impact and could be most readily adopted. The commission also asked what action ICSs would like government to take nationally to underpin their local efforts. It also raised the question of what ICSs can and should do to monitor the impact of those pressures on residents and their workforce, and how they should use this data to inform decision making and influencing activities.
Speaking at the roundtable. associate director of the Health Foundation David Finch quantified the impact of the crisis on individuals. The closer people are to higher average incomes the better health is on average, and places nearer to the north of England tend to be towards the bottom end of that scale. Having poor health can also affect the amount of income you have, he added.
He pointed out the impact of relative deprivation: ‘Although you may have adequate incomes and be surviving as such, there is still a stress associated with lacking goods and services you need and having the status of being able to engage in mainstream society’. Much of this has long-term implications, ‘and research shows that any exposure to poverty as a child is associated with worse health over the lifetime’, he said.
He showed data from before and after the pandemic demonstrating a very big increase in the proportion of people not able to afford basic essentials and in those not able to switch their heating on when needed. There has also been a significant increase in the proportion of families reporting that they are unable to afford enough food. More single parent families are struggling. All family types are impacted but it is particularly an issue for those with more children.
He warned of a potential ‘long term slow burn effect’ where people will be increasingly affected by their wages not keeping up with the rise in prices, and level of debt is one of the indicators that this is happening. He added: ‘For those on the lowest income, the number of people reporting that debt has increased has more than doubled since the early part of February 2020’.
One questioner asked how it was possible to prepare people for the unexpected shocks that have hit communities and whether an ICS could influence something as complex and difficult as communities and local connections.
In response, chief executive of North East London ICS and the former chief executive of Haringey LBC Zina Etheridge said: ‘If we think about the last 10 to 15 years and all of the things that happened – the 2008 financial crisis, austerity, the pandemic, coming out of the pandemic and then a cost of living crisis - there’s a huge amount going on in there.
‘This has had really complex effects on people’s social and economic wellbeing, and the ability of people in communities to really deal with those challenges. That is something we need to think and talk about more.’
Undoubtedly there is not enough money, she believes. ‘But it’s not just money, it’s access to other resources as well. It’s access to the social resources and social capital that enable people into better paid employment, it’s access to things in their local community which enable them to participate in the community.’
She said that ‘one of the things we can do is make sure we are really building co-production into the work that we do so that we are hearing everybody’s voices as we are developing our strategies and as we are improving and developing our services’.
Her ICB, she added, is trying to ‘work really closely at local level with local authorities, with the voluntary and community sector to make sure we understand what’s happening in our communities and what they need, and then design services to support that’.
Much could be done through sharing data better, in her view. But she said it was crucial to understand the impact of poverty as ‘a particularly deep seam’ sitting under the cost of living crisis. She added: ‘We need to get better at thinking and understanding and building into the work we do the impact of poverty on people’s health.’
How embedded are councils with this agenda? ‘My councils are brilliant’, said Ms Etheridge. ‘I’d like to put in a real plug for them. They are really supportive, they’re really engaged. We’ve asked each of our places to have a place leader [for health and care] and lots of our local authority chief executives have stepped forward to take on that role.’ That engagement may not be as strong elsewhere, she hints. ‘Obviously relationships differ around the country.’
Chair of NHS West Yorkshire ICS Cathy Elliot put an emphasis on the need for practical solutions. She said it was time to ‘give leaders some really straightforward things to do together and if you do one thing it’s better than trying to work out lots of things you can’t do or you haven’t got time to do.’
Partners including councils working within ICSs may be determined to deal with the cost of living challenge. But it remains to be seen if the principles of integration, prevention and early intervention will flourish in time to make a significant difference, particularly in poverty-blighted communities.
