Healthier, Wealthier Children Pauline Craig Glasgow Centre for Population Health

Background Work to increase Healthy Start uptake found that back up was needed to support benefit related issues At the same time NHS Greater Glasgow and Clyde Financial Inclusion Strategy Group recognised a need for work on child poverty Opportunity to seek funding from Scottish Government (Employability and Tackling Poverty, formerly Financial Inclusion Division) System support for shifting focus to early years: CMO, GGCNHS DPH report, Glasgow Health Commission

Case study for Healthy Start: Is £3.10 worth the hassle? Single mother, no work, two children (8 and 3) difficult relationship with father – now left, devastated to be pregnant again Food budget £3 per day per head = £63 per week (Guardian Society, April 2009) Eligible for two vouchers = 10% of weekly shopping bill

Courtesy of Bruce Whyte and David Walsh at GCPH

Impact of welfare reforms on families with children, June 2010 Reduce eligibility threshold for Child Tax Credit for the full family element down from £50,000 to £40,000 (although larger families with high childcare costs or disabled children may still be eligible with income higher than £40,000) Freeze on child benefit rates for three years Stop Health in Pregnancy Grant and restrict Sure Start Maternity Grant Stop Child Trust Fund payments Remove the ‘baby element’ from the Child Tax Credit Reduced maximum housing benefit payable Forthcoming VAT rise will disproportionately affect people on a lower income (from CPAG in Scotland presentation, Mark Willis, 2010).

Evidence base for HWC Income is a determinant of health (Marmot, 2010; Spencer, 2008) Early years are crucial for children’s physical, emotional and social development (Harvard Center on the Developing Child, 2007) Better quality of life through the lifecourse with better diet, opportunities, reduced stress etc from before birth (Bartley et al, 2006; Growing Up in Scotland, 2010) Financial inclusion services evaluations suggest improved mental health with improved income (Gillespie, 2010) Childbirth and relationship breakdown are major risk events for falling into child poverty (McQuaid et al, 2010) Disproportionate impact of poverty on women in couples (McKay, 2009) and on lone parents, most of whom are women (Lister, 2006)

Healthier, Wealthier Children £1,058,000 from SG Employability and Tackling Poverty Division for NHS GGC in partnership with GCPH, GCC and CH/CPs Aim to reduce and prevent adverse impact of poverty on children’s health and well-being, by building practical expertise in child poverty and working through universal health services to maximise prevention Target life stages at high risk of child poverty: pregnant women and families with young children or older children with additional care needs (incl disability, kinship carers, asylum seekers) Income maximisation services linked to all 10 CH/CPs including children and families services, antenatal, mental health and addictions Local links to early years, childcare, employability and other financial inclusion support services

Criteria for inclusion Referral Criteria (Please tick at least one from each box) Family structure 2. Target group Pregnant Total household income below £40,000 Child/children under 5 Additional family risk factors (eg kinship carers, addictions, mental health) Child/Children under 19 with additional support needs Ineligible for benefits due to immigration status

Objectives 1. Strengthen and develop knowledge and expertise within financial inclusion and health services for addressing child poverty Commissioned financial inclusion services through CH/CPs to provide local income maximisation support for target group referred in from health and other services Employed a development worker in each CH/CP and Addictions to improve local knowledge of links between child poverty and health, and build awareness of need and referral pathways into routine health consultations

2. Influence future commissioning and delivery of mainstream services for sustainability of information and referral pathways beyond project Provide guidelines for commissioning income maximisation services for families with young children based on need and experience of HWC service use Build addressing child poverty into health service strategy and practice – eg public health performance management, questions about Healthy Start and money worries within midwives and health visitor assessments, Infant Feeding Pathway etc

3. Evaluate impact and identify models of good practice for dissemination across Scotland Use of and benefits of service to families Impact of partnership working: across GGC health system; across health and council strategy; local CH/CP and CPP partnerships between health, council and voluntary sector 10 models of service provision meeting 10 different levels and types of need

Healthier, Wealthier Children Lines of action, reporting and influence Scottish Government Employability & Poverty Division (Funders) NHS GGC Corporate Management Team Local Authority Financial Inclusion Structures LA and CPP Structures Eg GCC Child Poverty Sub Group NHS Financial Inclusion Strategy Group GCPH Evaluation & Monitoring Sub Group 11 Project Teams (10 CH/CPs & Addiction) NHS & Income Maximisers Project Steering Group Co-ordination Development Learning National Networks CH/CPs, CPPs Early Years Antenatal services Mental Health Addictions Health Improvement Homelessness Action Learning Sets Action Reporting Influence

Progress, Sept 2010 Multidisciplinary and multiagency Steering Group established and active since March: health, councils financial inclusion, early years, voluntary sector, Scottish Government Local services and development workers almost all in place Evaluation team started Agreeing criteria for inclusion and monitoring of services Strategies for EQIA, engagement and communication underway

Reviewing and reporting Service provision and monitoring established from 1st October Review in January: criteria, referral form, monitoring strategy Interim report summer 2011 Final report early 2012.