Joining it up – Health Inequalities, Voluntary Sector Data and Citizens Advice Bureaux

Last year (Data, Health Inequalities and Localism) I wrote a piece on the potential that Voluntary Sector data has to help Health and Wellbeing Boards get a more rounded view of what is happening in their communities.

Since then there has been an increase in activity in this area – I want to focus on work that the Citizens Advice analytical team have led with support from the Department of Health.

All CAB use a standard data set. Citizens Advice has developed a template to capture this local data so that a bureau can provide a strategic picture on the social determinants of health to feed into of Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies. This begins to address a long standing concern of mine – that Bureau data is good at helping Citizens Advice make social policy arguments to government but has not been seen as a resource to  help Bureaux provide local commissioners with information.

The template includes an introduction by Sir Michael Marmot (Institute of Health Equity). This provides a simple and clear explanation about the relevance of information and welfare rights services to actions that tackle heath inequalities.

The introduction itself is a useful advocacy tool to explain to sceptical public health professionals or members of Health and Wellbeing Boards why welfare rights and information services have a key role to play in tackling health inequalities. I have made it available here – Sir Michael Marmot Introduction.

Two of the Bureaux who have already used these templates to produce reports for their local health system are Shropshire and Wolverhampton.

The template report is structured into sections that show:

• Where people who use the CAB service live and the relationship this has to deprivation
• Responses to key social determinants of health such as Child Poverty, Fuel Poverty, Homelessness, Domestic Abuse, Environmental and Neighbour Problems.
• Vulnerable groups of people such as those with a disability and long term health problems.

The template report concludes with a short section on emerging needs. These are short reports – but they provide useful insights into need – here is an example looking at useage by people who live in the most deprived 20% of neighbourhoods.

Shropshire

In the case of Shropshire of the 9,009 people they saw in 2011/12 the 4 big issues were benefits and tax credits, debt, employment and housing.

The Shropshire CAB report Health and Poverty records that they saw 438 clients who lived in the 20% most deprived Super Output Areas. I reckon – multiplying this figure by 2.4 (to 1051) to allow for households (Source is ONS April 2012) this equates to approximately 12.5% of families  living in those communities using the bureau. This calculation is based on the IMD for 2010 that states that there were 8,402 adults and children living in the most deprived quintile in Shropshire in 2010. So, 1051/8402)X100 = 12.5%.

The same approach could also be used when looking at issues such as Long Term Conditions and Disability.

Wolverhampton

The Wolverhampton CAB report The Health Impact of Good Advice uses the same basic template as  Shropshire but contains much more detail. These are of course very different places – Wolverhampton is much more deprived and urban – Shropshire is a sparsely populated rural authority. Wolverhampton provided a service in 2010/11 to 10,357 people of whom 6,348 lived in the most deprived quintile. (IMD figures for 2010 show that almost 52% of Wolverhampton residents – 129,740 people – live in the most deprived quintile (population 249,500, 2011 census). Therefore Wolverhampton CAB saw roughly 12% of families living in the most deprived areas in the City.

My contention is that this level of connection – about 12% –  with some of the most hard pressed families is impressive – these are small voluntary organisations who as well as providing a meaningful service are now able to provide information that goes some way to increasing the potential for a powerful local dialogue about:

• What is happening to some of the most vulnerable people in local authority areas
• Whether services are sufficient
• Which services are actually in contact with easily ignored communities and what potential there might be for extending the reach of other services through this.

If you are not impressed with this degree of contact – ask yourself the question – what proportion of these communities do public health programmes like smoking cessation, walking for health and healthy eating programmes etc reach?

A further step

Finally, Wolverhampton have taken this and other data and produced a short social policy report called Where to next, Poor city? This is a really helpful document starting to use the experience and insights from a comparatively small voluntary organisation to bring a thoughtful strategic social policy analysis to local commissioners.

Here is some information from ‘Where to next, poor city?’

• Housing Benefit cuts affect 4,000 households – there were 97,000 households in 2001
• 15,000 Disabled Claimants face re-assessment
• £80m is outstanding in County Court Judgements which will exlcude 1/3 of households from accessing normal high street credit.
• There are over 31,000 doorstep/pay day loans running
• In Wolverhampton 6% of local households recieve a monthly food parcel

This is a bleak but realistic picture. However, there is a real opportunity here. The trail blazing work by bureaux like Wolverhampton and Shropshire helps to contribute to a genuinely different discourse that focusses on the ‘causes of the causes’ and starts to help local authorities in particular champion their own public health priorities.

In Wolverhampton Jeremy Vanes the CAB Chief Executive talks about answering one question only – ‘how do we make every local household financially sustainable”?

What needs to happen

Local Commissioners should:

• Pro-actively engage with local CAB supporting and encouraging them to use their information.

• They should consider how they can put this information alongside information they hold to broaden and strengthen the analysis – particularly from a population perspective.

• They should consider how they can utilise the connectedness that local bureau have to work with CAB to build other health and wellbeing services around them and whether additional investment would help Bureau reach out to more people who are in greatest need.

What do you think?