Why I’m optimistic about the NHS’s ability to tackle poverty despite the stats

Given the depth and scale of poverty today, I feel strangely optimistic about the NHS’s ability to tackle both poverty and poverty stigma, despite the concerns I set out in my earlier blog about how the NHS contributes to the stigma that surrounds adult poverty. There are clear signs that the NHS is more than capable of doing this work, and in some cases has already begun.

Take the poverty proofing work undertaken by Children North East. They are applying what they learnt from Poverty Proofing© the School Day to health services for families and children. As their operations director, Michele Deans, explained, ‘It’s about the small stuff and the big stuff’. It’s about realising that some children with diabetes are unable to take advantage of the latest life-changing technologies because their families cannot afford the smartphone or computer that is needed for use with continuous glucose monitors. Children North East's work on diabetes care shows that excellent clinical practice is pointless if people don’t have sufficient financial resources to get to an appointment, or to access the technology, food, or the opportunities to exercise that will help them maintain or improve their health.

It’s about realising that some children with diabetes are unable to take advantage of the latest life-changing technologies because their families cannot afford the smartphone or computer that is needed for use with continuous glucose monitors.

Poverty undermines people’s ability to use health and care services, and to stay as healthy as they can in many ways – and in ways that are not always obvious. Paying for food and drinks while your child is in hospital may not sound like a priority for a stretched children’s service struggling to meet demand, but parents worry about not being able to find affordable or healthy food at a time of high anxiety.

Children also see how stressed their parents can become when they have to rely on expensive hospital food outlets and vending machines. One nine-year-old girl called Sophie, who had cancer, wanted to make sure things improved as part of her legacy. Inspired by Sophie, the Children’s Hospital Alliance focused its improvement work on how to ensure families have access to healthy and affordable food while their child is in hospital. Nine hospitals piloted different approaches to free or subsidised food. Parents welcomed these schemes, but uptake was higher when parents didn’t have to request a voucher to obtain the food. This finding chimes with other evaluations of health and welfare schemes which show that stigma can be a powerful barrier to accessing support.

Unsurprisingly, food is never far from discussions about poverty and health. And food insecurity doesn’t just impede our physical health but our mental health, too. If you want to understand better the mental anguish that food insecurity brings, I’d recommend listening to what people using the Cambridge Food Bank shared. You’ll hear people describe honestly the personal devastating impact of being put in a position where they can’t afford to eat. The food bank has found one way to help tackle the stigma of poverty and feelings of personal failure by setting up a social supermarket called the Fairbite Club. For a £2 membership, people can buy high-quality food at a subsidised rate. As Dr Liam Loftus, a GP registrar who works on behalf of Cambridge City Foodbank as a health inequalities consultant, explained, ‘‘The social supermarket is more than a place people can get subsidised healthy food. There’s now a community among the 150 members who meet before the shop opens to socialise, share recipes, and do cooking sessions together. It’s also tackling the root causes of poverty – giving people access to Citizen’s Advice and support around jobs and housing.’’

This finding chimes with other evaluations of health and welfare schemes which show that stigma can be a powerful barrier to accessing support.

What's happening in Greater Manchester also gives me hope. In partnership with Greater Manchester Poverty Action, NHS GM is taking an ambitious, system-wide and multi-pronged approach to tackling poverty and poverty stigma. They have now trained over 600 NHS staff in poverty awareness, surveyed residents and staff, and involved people experiencing socio-economic disadvantage in developing and implementing the strategy. Their Cost of Living Dashboard is one of the ways they are using data to track and understand the impact of poverty in the region. David Boulger, Assistant Director, Population Health, explained that the integrated care board’s anti-poverty work is now locked into the governance of the system: ‘It’s not seen as discretionary’.

It is hard to see how the NHS could continue to view poverty as a discretionary issue given the impact poverty is already having on people’s health, and on people’s access to the NHS. In a perverse kind of logic, perhaps the cost-of-living crisis has helped bring the issue of financial insecurity into the open – making poverty more visible for those that work in, volunteer and use health and care. So be open, ask questions, and bring poverty into your conversations.