This blog is based on a talk I gave at the recent Faculty of Public Health Conference – reacting to the Ken Loach film I Daniel Blake.
In a recent blog I set out how public health has struggled to recognise the important contribution that the benefits system makes to wellbeing and tackling health inequalities. We need to think of the benefit system as a public health service.
Nonetheless, we are in a position where this crucially important Public Health Service is increasingly difficult to access and where it is even hard to have a discussion at a local level about how we can ensure that vulnerable populations make best use of it.
A reminder – the NHS budget is just over £100 billion a year and the social welfare spend is £126 billion – not including pensions.
In fact as the figure below from Simon Duffy (Centre for Welfare Reform) shows the actual cost of social welfare to the state is considerably less than this.
When it comes to public health strategies and practice at a national level we look to two agencies to scope the landscape – Public Heath England and NICE. Between them they would argue that they describe the strategic public health challenges and actions needed to improve population health and tackle health inequalities.
At the conference we heard that this is not the case. Both agencies work within the constraints of Government Policy – Public Heath England strategic focus has to be consistent with the government agenda – not only does it not publicly challenge DWP actions – the only time it mentions welfare payments in its strategies is with regard to actions that will reduce their take up! It also does not offer strategies and actions to ensure that the benefit system is used to its best effect.
NICE works to a shopping list of priorities signed off by Government – again this list does not include welfare benefits.
This means that we must not accept that the Public Health England Strategy includes all the issues we need to address and the actions we can take or that it even includes the most important ones! In fact the Public Health England strategy is based on a mixture of evidence and a government ideology.
Luckily, local Public Health teams have a degree of autonomy from central government. However there are challenges here too. It is quite difficult to have a system level conversation about access to the welfare benefit system – I think that this is for three reasons:
- Poisoned Minds – Local leaders find it difficult to engage with an issue that has been represented by large elements of the press and respective governments as being about scroungers and layabouts.
- Pot of gold – Partly for the reason above local decision makers would rather focus on creating employment and getting people off benefits which is of course commendable. However, there are many unable to work, low paid jobs rely on benefit top up and there is some evidence that people with good financial security through appropriate welfare support are likely to find employment more quickly than those ‘incentivised’ through punitive benefit regimes.
- Welfare Economy – I suspect that some local leaders worry that a focus on improving access to the benefit system will lead to accusations that they lack ambition and are building an economy that is dependent on ‘handouts’.
Five actions for local Public Health.
- Narrative and Conversation – have a strategic conversation at an appropriate level which considers what is known about need, levels of financial insecurity and demand on benefits services (this is difficult because DWP release little local data). Data sources could include StepChange, Citizens Advice, Insolvency Judgement trends, Public Health funeral (Paupers Funeral) trends, local Food Bank data etc. Organisations like the Centre for Welfare Reform and the Money and Mental Health Policy Unit can offer analysis.
- Investment – consider the current level of investment in welfare rights services – what stories do providers tell of the strategic picture? Too often their data is kept at contract manager level in local systems rather than being used to develop strategies.
- Focus – Often local Citizens Advice Services are left to get on with it – there is plenty of demand out there. Local commissioners need to understand the whole population effect – in particular are services targeted on the most vulnerable? For example:
- People with mental health problems such as those receiving IAPT or on the Care Programme Approach
- People with progressive long term conditions such as Cancer – Macmillan has done tremendous work here
- Families in poverty especially those who are expecting new children
- Collaboration – Local Public Heath teams can help by pulling together welfare rights providers and NHS provider and commissioners to consider how to strengthen the contribution of welfare benefits to people with long term conditions.
- Evidence – local Citizens Advice services have a long track record of translating issues faced by their clients into evidence to challenge policy (I gave a Sheffield example here) local Public Health Teams need to consider how they can strengthen this.
What do you think?