Child poverty, health and wellbeing Kerry McKenzie, NHS Health Scotland

Outline Child poverty in Scotland Impact of poverty on health and wellbeing of children and families Causes of child poverty The role of universal NHS services in mitigating the impact of child poverty – financial inclusion referral pathways

Source: Scottish Government (2017) 2015/16 Poverty and Income Inequality in Scotland: 2015/16

Relative child poverty Source: Scottish Government (2017) 2015/16 Poverty and Income Inequality in Scotland: 2015/16

Percentage of children and working age adults in poverty After Housing Costs, living in a household with at least one adult in employment Source: Scottish Government (2017) 2015/16 Poverty and Income Inequality in Scotland: 2015/16

Impact of poverty on child health and wellbeing

‘Those children from the most deprived backgrounds are experiencing much worse health compared with the most affluent….. ……more likely to have negative health outcomes, to be born with low birth weight or fail to thrive and be exposed to risks that perpetuate ill health such as poor diet, lack of physical activity, parental drug or alcohol misuse and being in care……… ….More must be done to reduce the number of children living in poverty in Scotland and to minimise the impact of deprivation on health outcomes.’ The State of Child Health 2017 Recommendations for Scotland Royal College of Paediatric and Child Health http://www.rcpch.ac.uk/system/files/protected/page/SOCH-recommendations-Scotland.pdf

Causes of child poverty In-work poverty due to low wages and underemployment, unpredictable working hours, precarious employment Inadequate social security benefits/system ‘Welfare reform’

Impact of welfare reform…. ….on women And the impact being overwhelmingly felt by women …………Since 2010, £26 billion worth of cuts have been made to benefits, tax credits, pay and pensions. 85% of this has been taken from women’s incomes. Source: Engender (2015) http://www.engender.org.uk/content/publications/Engender-Submission-to-the- Welfare-Reform-Committee-Inquiry-into-Women-and-Welfare.pdf …..on lone parents Negative impact of changes on income level is more severe amongst this group

Impact on children and families in Scotland? http://www.cpag.org.uk/scotland/early-warning-system

Financial losses to claimants? Estimates per annum based on post-2015 reforms by 2020/21: £1bn financial loss in Scotland pa Families with dependent children hit hardest Largest losses fall in poorest areas In addition to the financial losses from pre-2015 reforms Source: Beattie, C & Fothergill, S (2016) The Impact on Scotland of the New Welfare Reforms. Available from http://www.parliament.scot/S5_Social_Security/General%20Documents/Sheffield- Hallam_FINAL_version_07.10.16.pdf

Unclaimed entitlements £260m of Jobseekers Allowance (JSA), Employment Support Allowance and Income Support unclaimed only 56% of families with children entitled to JSA received it in 2014/15 Sources: DWP (2015) Fraud and Error in the Benefit System 2014/15 Preliminary Estimates (Great Britain); DWP (2016) Income-related benefits: estimates of take-up data for financial year 2014/15 Available from here: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/535362/ir-benefits-take-up-main- report-2014-15.pdf

The role of universal NHS services in mitigation? Midwives and health visitors Asking pregnant woman and families with young children about money issues as part of routine enquiry Active referral pathway to local advice service that is sensitive to needs of pregnant women and families with children Supported by learning and workforce development (awareness raising and understanding of poverty and its impact on health and wellbeing) Policy context: Universal Pathway for Health Visiting http://www.gov.scot/Resource/0048/00487884.pdf Scottish Woman-Held Maternity Record So what can help? An example of an intervention that helps to mitigate the effects of poverty is financial inclusion and it includes a range of support income maximisation, debt advice, access to bank accounts, fuel poverty advice………………… A range of health professionals are now asking the people they care for about money worries and offering a referral to an advice service. The example from the universal services of midwifery and health visiting is outlined here.

Local partnerships across the boundaries Partnership agreements between the NHS and the advice sector need to be in place for the commissioning and delivery of advice with appropriate service level agreements Simple and easy to follow referral pathways established between midwifery & health visiting services and the advice service Provide active or supported referrals i.e. health professional make the referral (and not just sign-post) to an appointment based advice service with proactive follow-up by the advice service

Example: Healthier Wealthier Children Between 2010 and 2016 there have been 11103 referrals made through Healthier Wealthier Children (from Midwives and Health Visitors) Resulting in estimated financial gains of over £11,658,777 for families across Greater Glasgow & Clyde http://www.nhsggc.org.uk/your-health/campaigns/healthier-wealthier-children/

Royal Hospital for Children Glasgow Money and Debt Service 408 families used the service in 2016/17 resulting in £2.3m financial gain (unclaimed benefits and tax credits) Patients reported that they expected to be asked about their money worries as part of the overall service from the NHS and regarded it as a routine element of support http://www.rcpch.ac.uk/system/files/protected/page/Final%20Version%20of%20Yorkhill%20Report%20%20(2).pdf

QUESTIONS?