We are in for a very tough time over the next couple of years … and it will be the poorest who carry the greatest personal burden.
This is the time when the NHS needs to be looking hard at how it provides services so that they are delivered in a way that recognises the terrible financial pressures that people face.
I have had a look at the three Integrated Care Boards (ICB) in Yorkshire and was heartened to see that each had a paper which is specifically about the impact of financial insecurity on the health of the populations they serve.
Actions
Two of the papers – WYICP alleviating poverty report and Humber and North Yorkshire ICS had been discussed at the wider Integrated Care Partnership (ICP) too – this feels right, because the wider voluntary and community sector and local government already have a track record here.
The South Yorkshire paper has only been to the ICB so far – it’s more of a discussion paper – without specific recommended actions.
The other two papers suggest actions that include:
- We need to better at bringing population based data that is relevant to the ICS specifically on inequality and financial insecurity.
- NHS and care staff need to be provided with training and support about the impact of financial insecurity on their patients so that they can signpost and advise.
- Thought needs to be given to how access to welfare advice and support is given within key pathways.
- The role of the NHS providers as key economic anchors needs to be utilised
- NHS and Social Care staff who are experiencing financial insecurity need to be helped
Leadership
West Yorkshire and Humber and North Yorkshire recommend establishing strategic groups to keep a grip on this agenda and to be accountable for a response. Humber and North Yorkshire ICB has used their helicopter view to provide an appendix summarising approaches being taken in each place and by each NHS organisation. This is helpful although there is no overarching analysis of this.
What do I think?
The papers help, although they default too easily to rather grand system change ideas rather than focussing on actions that address the immediate crisis. For example talking about the role of the NHS as an economic anchor is fine but ain’t going to address current challenges. The reasons why the NHS needs to step up here is better explained by organisations outside the NHS such as Macmillan and the Money and Mental Health Policy Institute.
I think the NHS needs to focus primarily on practical actions that health systems can take now that will improve peoples financial insecurity and benefit the NHS. This will require cultural change and modernising what we think good clinical practice is.
Calls for more work on understanding population data better is probably a distraction. It is perfectly possible to establish a framework based on health impact/need for NHS services/financial vulnerability that can play to the strength of NHS clinical delivery models – by focussing on particular conditions and defined populations. The generally rather bland Kings Fund think piece has a good example of this below. I have written extensively on this using examples such as the Cancer, Major Trauma, Mental Health, Progressive Illnesses etc.
There is money
There is funding out there available to help people. The online advice service ‘entitledto’ produce a yearly analysis of how much benefits are unclaimed each year. Their estimate for 2022 is £15bn across the UK. This equates to roughly £1.2bn available for people in Yorkshire. I challenge any NHS ICS to propose an alternative course of action that would help people as significantly as enabling people to access these unclaimed benefits.
The reality is that vulnerable people experiencing traumatic health conditions need expert help to access the benefits they are entitled to.
I think that the NHS has a key role to play in helping get this money into peoples pockets by funding dedicated welfare rights services. There are too few examples of this – in Sheffield the NHS funds a welfare rights service specifically for people experiencing acute mental health problems.
Actions
We need an action plan which:
- is informed by services on the front line who are tackling financial insecurity and health. Such as national ones like Macmillan and the Money and Mental Health Policy Institute and local ones such as Local Citizens Advice.
- is about impact over the next 2 years
- invests NHS funding directly into welfare rights services that are integrated into key clinical services – not distractions such as social prescribing
- focuses on areas where the toxic combination of a significant health problem and financial insecurity impact on NHS utilisation and personal recovery.
- What do you think?
Disclosure – I am Chair of Citizens Advice Sheffield