Let Them Eat Cake

Published in The Guardian

Despite petitions and public protestations, The Prime Minister, Boris Johnson is sticking by his guns. The Health Secretary, Matt Hancock is insisting that the Government are already doing enough, with an array of other white men in suits telling us why he’s right, whilst ignoring the voices of over 2000 leading Paediatricians (what do they know, anyway?!).  Whilst Marcus Rashford calls them to account and celebrates the great swell of public support, they want others to step up to the plate and take responsibility. But there seems to be a significant difference to what the government believe they are doing about the issue, what local councils are receiving in terms of help and what communities are experiencing. Learning to listen is one of the core facets of compassionate leadership.

 

“Of all the skills of leadership, listening is the most valuable — and one of the least understood. Most captains of industry listen only sometimes, and they remain ordinary leaders. But a few, the great ones, never stop listening. That’s how they get word before anyone else of unseen problems and opportunities.”

— Peter Nulty, Fortune Magazine

 

Here in Morecambe Bay, I’ve had the privilege of hearing Trina, a brilliant member of the community in Morecambe, give her testimony to Heidi Allen MP and Frank Field MP from the select committee for the Department of Work and Pensions, and more recently to the Chief Medical Officer, Prof Chris Whitty, when he visited the Bay. Trina is an amazing woman. She keeps a freezer full off food in her front room to feed members of her local community who are on the ropes or have been sanctioned. She knows what it is to live with the experience of poverty and the complex issues involved. I love the way in which she fearlessly speaks truth to power:

 

“Ending up on benefits isn’t always as simple as losing your job. It can be the result of bereavement, illness, injury, or a breakdown in a relationship. It’s a culture shock. For me, one day I had a grand a week coming in. The next day I was applying for IS. It took 14 weeks for my payments to come in. 14 weeks where I still had to pay the rent, pay bills, feed my child. You default on anything on a contract. Worry about it later. And you sell all your ‘nice things’ for pence, to keep a roof over your head. Then the fridge breaks – or the cooker, or the washer – but you’re still only getting your IS payment, not housing benefit or tax credits. It’s different now, it’s all UC – but that’s harder, coz it’s all rolled into one so you don’t even get that small amount of IS. With no other option (you can’t get normal credit) you go to Brighthouse (or the current equivalent) or you get a loan from Deebank/Provident/Greenwoods. You pay 4x as much back in total, but it’s only £5 per week. Your credit rating gets worse because you’ve defaulted on all your ‘luxuries’ – contract phone, sky tv, landline phone. Debts become bailiffs knocking on your door, and if you hide from them long enough… county court judgements. You’re still trying to learn to re-budget on less than 30% of what you used to have. All whilst dealing with illness, bereavement, disability, or social workers on your case because you were a DV victim and the police involved them. You move house because you can’t afford the rent. Then you’re sanctioned. Because despite telling the job centre three times that you’ve moved, they sent your appointment letter to the wrong house. Or you were in hospital. Or your child was sick. You appeal, but they uphold the sanction. You try to re-budget again. Your ex-partner decides they don’t want to bother with the kids anymore. So they stop paying child support and disappear. The CSA/CMS ‘can’t find them’ despite you providing their address and phone number. You try to re-budget it again. If that doesn’t make you think twice about judging people in poverty, consider going through that – which was my experience in 2009 – in the midst of a global pandemic, when there’s no jobs, food has gone up 60% you’re frightened to leave the house in case you get sick….And the world and his wife are taking to social media to espouse how you’re a shit parent and need your kids taken off you, because no matter how hard you try to explain that you’re not a scrounger, they tell you that you should use your non-existent money to just make soup.”

Trina’s experience is replicated thousands of times over. And whilst national leaders tell us they have already done enough and it’s not their responsibility to ensure that children are fed, let us examine these claims, with some help from the BBC.

 

The BBC ask – How much money is the government spending?

By BBC Reality Check

 

“Earlier, when pressed on free school meals, the prime minister told the BBC “there’s £63m specifically to help deal with holiday hunger and with pressure on families,” referring to payment made to local authorities in June.

However, the £63m was for a “local welfare assistance fund” to “assist those struggling to afford food and other essentials” and was not just to feed children.

Guidance for the funding stated that the government “anticipates that most of the funding will be spent within 12 weeks”, meaning that it was expected to have been spent before the end of September.

In England, about 1.3 million children claimed for free school meals in 2019 – about 15% of state-educated pupils.

Analysis by the Food Foundation estimates a further 900,000 children in England may have sought free school meals since the start of the pandemic.”

 

SO – just to be REALLY clear – the £63 million the government are talking about has ALREADY been given to councils (in August) and has ALREADY run out (as by the government’s own admission it was only expected to last for 12 weeks from the time it was given). It amounted to 34 pence per child, per day (the maths is fairly straight forward – £63million, divided by £2.2million – the number of children now needing Free School meals, see above facts from the BBC and then dividing this amount by 84 days – that is the 12 weeks for which the funding lasted). The government keep saying that they have funded councils to fund FSM vouchers, but a) this is no longer the case – the money has run out (as the Conservative Leader of Warwickshire County Council informed the government) AND b) it was woefully insufficient anyway to provide adequate nutrition! This all matters because the government are telling us that they are doing enough, but they plainly are not.

 

The things is that most of us find it hard to comprehend the difference between a million and a billion pounds, because we never encounter that kind of money. I find this graphic from reddit really helpful because it demonstrates it in a simple form. £63 million sounds like a lot of money, until you compare it to the £12 billion the government have spent on an ineffective test and trace system. They seem to be able to find massive funds for public health schemes which are failing, on the one hand, whilst unable to do provide sufficient funds for programmes that we know make a very real difference, you know – feeding hungry children.

 

With food bills possibly set to rise as the prospect of a no-deal Brexit becomes all the more real, the problem of hunger, not only for those already in poverty, but for many more families, currently just about holding it together will be felt ever more acutely. History teaches us that widespread hunger leads to civil unrest and sometimes even revolution. Now is not the time to remain entrenched in ideology. Now is the time for humble listening, and a change of heart. When the people are unable to buy bread, beware of the detached and senseless arrogance that cries, “Let them eat cake!”

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Poverty and Health Inequalities – What Can We Do?

Last week the Chief Medical Officer, Professor Chris Whitty, came up to Lancashire. He spent the morning in Blackpool and then came over to see us in Morecambe Bay for the afternoon. It was an absolute pleasure to meet him and to welcome him here. He came to listen – the mark a genuinely kind and caring leader. More importantly he came to listen to people who live in these Northern Coastal Communities, to really hear what life is like and to allow that to impact his thinking and he prepares to develop further strategy on tackling poverty and health inequalities. As an epidemiologist, he is grounded in data and understands the issues at hand. What I really valued was his humanity and humility as he listened to the stories of people who live and work here.

 

Last year, the Home Secretary, Pritti Patel also visited Morecambe Bay. She came to Barrow-in-Furness and spent some time at The Well, a CIC which works with people in recovery from addiction and of which I am a Director. In an interview afterwards, she was asked about the impact of Austerity and the reality of poverty in communities like ours (4 in 10 children in Barrow grow up in poverty). Her answer was that poverty is not the (sole) responsibility of government. I put sole in brackets, because she tried to insinuate that the role of central government in tackling poverty that exists in local areas is very minimal compared to the responsibility of local government (who have had their funding massively cut by central government in the last 10 years), local schools, local public services and local businesses. I’ve really wrestled with what she said since that time because she’s not altogether wrong! But nor is she right! Of course Central Government has a huge role to play in tackling poverty. It’s undeniable that national policy, economic strategy, including taxation, land ownership and business development all have massive implications. But poverty doesn’t only exist because of Central Government. Health Inequalities do not just exist because of Central Government. I am not for one minute, negating or diminishing their role, but we do have to all ask ourselves why we see and tolerate such inequality and what we can all do to change this narrative. Because as Michael Marmot reminds us so powerfully in his book ‘The Health Gap’ – none of this is inevitable and it certainly doesn’t have to continue. Marmot holds that “if you want to understand why health is distributed the way it is, you have to understand society.” So if we want to understand society, then as Prof Bev Skeggs (Professor of Sociology at Lancaster University) so eloquently says: “Society is shaped by our values and what we value“.

 

If we are serious about ‘levelling up’, ‘resetting’ and tackling age old health inequalities then we have to understand that this is both complex, but also entirely possible and need not take 100 years! As Marmot says in his amazing book ‘The Health Gap’ – essential reading for anyone who cares about this issue – we must do something and we must do it now! Marmot’s research proves that health inequalities are not a footnote to the health problems we face, they are the major health problem. We can actually make significant and measurable differences in a short space of time – so why aren’t we doing more? In the rest of this blog I hope to look at how we can make a real difference to poverty and health inequalities in our communities. We all have a part to play, no matter who we are. This is absolutely an issue for central and local government, but it is also an issue for society as a whole in all its facets.

 

Prof Imogen Tyler has written a phenomenal book called ‘Stigma: The Machinery of Inequality’. It is, in my opinion, the most important book published this year (I know that sounds like an overstatement, but it isn’t!). I believe this must be our starting point when we talk about poverty and health inequality. If we don’t understand how we have all subconsciously and/or overtly accepted a narrative that ‘the poor are feckless and lazy and could just pull themselves up by their boot straps if they wanted to, because we all have the same opportunities,’ then we are blind to the reality of the stigma that surrounds poverty and how it is weaponised to maintain the status quo. The thing is – it’s not just the government who have used this narrative – it’s part of British culture. So many of our comedy programmes ridicule and scapegoat the poorest in our society – The Harry Enfield Show (‘The Slobs’), and Little Britain (Vicky Pollard) to name just two. think of how many reality TV shows, like ‘Benefits Street’ have reinforced the stereotypes. Our national press continue to bombard us with very particular perspectives on ‘benefits scroungers‘ and ‘migrant swarms‘ and we read it, we drink it in, and whether we like it or not, it embeds itself as a way of thinking in our minds. That’s how propaganda works. It creates a corporate mindset by ‘othering’ our fellow human beings and pitting us against one another, rather than bringing us together to collaboratively find solutions in a way that works for everyone.  It takes significant and sustained effort to do our own internal work around stigma, racism, white privilege, sexism and toxic masculinity. But if we want to build a society shaped by our values and what we really value then whoever we are – this is where we must begin. Our first work is to demolish the strongholds in our minds, challenge our unconscious biases and undo our ‘go to’ narratives, replacing them with deeper and better truths about the innate value in every human life. We must be determined to create the kind of language which reflects this because language gives substance to our thoughts and beliefs. This important work needs to weave its way through every part of our education system. This will take effect in shifting the corporate mindset through the way we teach history in our schools, for example, with a more honest appraisal of the negative effects of colonialism, or indeed how the feudal system continues to dominate the price of land and the unaffordability of good quality housing. We need to equip the rising generation with the tools they will need to undo the damaging ideologies of stigma and find solutions to the issues they are facing around social justice and climate change.

 

Imogen draws on the work of The Poverty Truth Commission, here in Morecambe Bay and in other places to highlight ways in which we can break down stigma, build friendships and create a kinder society. The Poverty Truth Commission gives us a real insight not only into how we break down stigma, but how the building of friendships across the dividing walls in our society creates a new political space from which we can create ‘the good life’ together. Our political systems have become far too removed from every day life and we need a radical shift from disengagement to much wider participation in community life and decision making. There are so many voices calling for this from all sides of the political spectrum. We so badly need to break out of our entrenched twitter-siloed positions and learn to curate the space for a more collaborative and co-operative form of political and economic conversation and prioritisation. It is, in my view, impossible to think about breaking down health inequalities without involving those who experience them most severely to be a part of finding the solutions. For further reading on this: Radical Help by Hilary Cottam, Rekindling Democracy by Cormac Russell and Greed is Dead: Politics After Individualism by Paul Collier and John Kay are all vital texts. This requires a much more local, devolved, participatory kind of politics – the kind of thing made possible through initiatives like ‘The Art of Hosting’, ‘Citizens Jurys’ and ‘People’s Assemblies’ underpinned by principles of love and kindness. In this way we can create much more realistic ‘deals’ (like the one in Wigan) between public sector organisations and people in our communities. This might all sound a bit wishy washy, but as Marmot demonstrates, “the lower people are in the socio-economic hierarchy, the less control people have over their lives.’ He argues that “tackling disempowerment is crucial for improving health and improving health equity” This is where the circular arguments about absolute or relative poverty are missing the point. When Philip Hammond stated as Chancellor of the Exchequer that he ‘doesn’t see poverty in the UK‘ – he was talking about absolute poverty and implying it isn’t an issue in the UK. He’s profoundly wrong. Economist Amartya Sen helps us understand this: “Relative inequality with respect to income translates into absolute inequality in capabilities: your freedom to be and do. It is not only how much money you have that matters for your health, but what you can do with what you have; which in turn, will be influenced by where you are.” Marmot argues that this means people in this position cannot participate in society with dignity. It is this active participation in ones own life and the life of the community around you, coupled with a sense that you can be part of the change that needs to happen which underpins the strap line for the poverty truth commission. “Nothing about us, without us, is for us.” If we want to tackle poverty and health inequalities in our society we have to radically include those who are currently most marginalised to be part of the change with us. We’re not trying to fix them. Together, we are trying to untangle the injustice that allows this kind of staggering inequality to continue.

 

The NHS is currently exploring its own role in tackling poverty and health inequalities. As the biggest employer in the country it has the opportunity to make a massive difference as an Anchor Institution, setting a good example and creating a network, both locally and nationally for other partners to collaborate with. Along with other local employers it can make a vast difference through positive employment schemes for people from poorer communities, paying a living wage, procuring locally and developing apprenticeship schemes, to name just a few ideas. We have developed a charter in Lancashire and South Cumbria, which we hope will be nationally available soon. I’ve previously written on the role of Primary Care Networks (PCNs) and how taking a ‘radical help’ approach with our communities could make a real difference at a local level. PCNs have a particular role in Population Health Management. This approach that we are focusing on across Lancashire and South Cumbria uses the best in data science and enables health teams to focus in on the areas of greatest need, working with those communities to bring about change through co-creation. If the NHS is really serious about ‘levelling up’, however, one thing which must be explored is the national funding formula. If we’re serious about Population Health, we must be much more comfortable with allocating resources according to Indices of Multiple Deprivation. We must also change what we measure and ensure that Key Performance Indicators and clinical funding streams are much more aligned to this entire agenda. Incentives do change behaviour and we need to make sure that we’re getting them right, whilst permissioning PCNs, in particular, to have a change in focus. We need to make it more attractive to work in areas of higher complexity and create more sustainable models of care. It is my belief that without a Health Inequalities lead at the top table of NHS England and Improvement, the right level of accountability and prioritisation simply won’t be there. It won’t be enough just to have someone accountable in each system, vital though this is. Integrated Care Systems must take an evidence-based approach and recognise what a profound difference they can make in a short space of time. The drivers in the system must be wedded to this way of working. The NHS must stop spending such a colossal amount of money tinkering around the edges of helping people to live a bit longer and get deep into the game of tackling the vast and ongoing health inequalities in our society. It must use it’s powerful voice to continually challenge policies which make this worse and actively campaign to make society more equitable. Marmot and The King’s Fund have already detailed so much that the NHS can do. Olivia Butterworth and Sara Bordoley and their teams are doing some great things. We need more of it! It’s time to act!

 

The issue of land and the lack of affordable housing has a huge effect on people being locked in cycles of poverty and creates massive health inequalities. Central Government has a huge role in sorting this out, but increased devolution may make it become easier with increased public participation in the daily politics of life. Most of the way our land is distributed and inflated was designed in the 11th Century and through the Middle Ages. Alistair Parvin has written the most phenomenal piece on this issue and it deserves time to be read and digested. He makes a very tight case as to why we find ourselves in the situation we are in, but encouragingly he comes up with some really possible, pragmatic and solutions-focused ideas about how we can solve this, if we want to. Of course there are many vested interested and people in positions of significant power, who would resist such an approach, but we must not let that stop us having some grown-up conversations about this. Parvin accepts that it would take a government with extraordinary vision and bravery to do what is really needed and offers some really helpful pragmatic smaller steps that would get us in the right direction.

 

I am not going to copy and paste his paper here, but I hope this whet’s your appetite enough to seriously engage in the possibilities. We can’t keep passing this ball to future generations. We have a once in a lifetime opportunity to reset our economy and in this time of ‘jubilee‘ we need to grasp this nettle if we are serious about creating a society that truly works for everyone. Mariana Mazzucato, Kate Raworth, Katherine Trebeck and Carlota Perez are just some of the brilliant people creating the kind of economic and technological frameworks we need. It’s time to build an economy of hope, shaped by our values and focusing on what we value. We know that the UK population would like us to place health and wellbeing at the heart of the UK economy instead of GDP – this is a massive shift and one that we must hold onto. This priority along with the creation of more social co-operatives, new local/community banks and credit unions would all help us to create a fairer economy that really works for the people.

 

 

So, we all have a role to play. As individuals, in our communities, through our work and via a more engaged, participatory, devolved, democracy, we need to deal with stigma and ‘wicked issues’, be determined to be more  switched on, truly engaged and find together some pragmatic solutions fit for the 21st century.  Disengagement is not an option. Let us not miss this moment. We can and we must do something. As Michael Marmot says in the final sentence of ‘The Health Gap’: “Do something. Do it more. Do it better.”

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A Vision for Population Health and Wellbeing – All Together We Can

Tweet If you haven’t yet had the chance to read the Kings Fund’s vision for population health (and it’s the kind of thing that interests you) then I would heartily recommend that you do so. (https://www.kingsfund.org.uk/publications/vision-population-health). It is a real ‘Tour de Force’ and deserves some significant consideration. I like it because it doesn’t hold [Continue Reading …]

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Choice and Responsibility

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Obesity – Genetic or Environmental?

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How Do We Build a City That Works For Everyone?

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Solutions for the NHS Workforce Crisis

Tweet This week, the Kingsfund, one of the most respected think-tanks on health and social care in the UK declared that the current NHS staffing levels are becoming a ‘national emergency’.   The latest figures have been published by the regulator, NHS Improvement, for the April to June period.   They showed: ■   11.8% [Continue Reading …]

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Health and Society – Part 3 – Can We Make a Difference?

Tweet On the 70th Birthday of the NHS, here is the 3rd and final part of this mini-vlog-series. In this one I look at how we can make some positive steps for our own health and wellbeing and explore the issues of choice and responsibility, whilst we also tackle health inequality and issues of social [Continue Reading …]

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Creating a Great Culture – Part 2

Tweet In the last blog, reflecting on the book “Legacy”, by James Kerr, I started to explore how the All Blacks have managed to create such an excellent culture; reflecting on what we can learn from it in the health and social care system (or indeed any environment).   Of the 15 principles outlined, I [Continue Reading …]

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Creating a Great Culture – Part 1

Tweet I’ve recently finished reading the extraordinary book, “Legacy”, by James Kerr. It is a book about the culture of The All Blacks, the most “successful” sports team in the world. If you are involved in leadership, at any level, especially if you are passionate about developing the culture of your team, I would heartily [Continue Reading …]

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