While Children Go Hungry…….

Marcus Rashford gettyimages-1257626131

I love Marcus Rashford! His statement on child hunger is brilliant, but I don’t entirely agree with him. In his impassioned plea for us to take child hunger seriously (which I could not agree with more), especially through the school holidays, he says: “this is not politics, this is humanity.” The reality is that EVERYTHING IS POLITICAL. Politics is about how we see the world and how we live together. Economics is about how we share and manage the resources between us. Child hunger and child poverty IS a political and economic issue! We can’t hide away from this. We can call for political unity over the issue, we can appeal to the deep compassion of the human heart – but we cannot try and de-politicise the issue, however hard we try. Nor can we remain silent, in case it looks like we’re playing party politics. I am not associated with any political party. None the less this is a deeply political issue – political with both a small p and a very big one!

 

Listening to the debate in the House of Commons about whether or not children should be given meals, provided by the state, during the school break, there seemed to be four main objections to the idea proffered by some of the Conservative MPs.

 

  1. Rather than give children meals, thereby nationalising them, we should be actively promoting parents to take more responsibility, rather than being absent and encourage them to provide for their children properly. We need to deal with the causes of the causes.
  2. If the state were to intervene, it only encourages dependency and laziness by parents who can’t  be bothered to provide for their children properly
  3. The state is already giving out quite enough help already, thank you very much, via Universal Credit.
  4. We’ve all got to play our part in helping out. We’ve had ‘eat out to help out’ for the rich, now we need ‘eat nowt to help out’ for the poor…..(slight tongue in cheek point, perhaps….)

 

Let’s just examine these from both a population health and social justice perspective:

 

  1. Well….I don’t know of very many parents who don’t want to ‘take responsibility’ for their children’s wellbeing. In fact there is hugely weaponised stigma and societal shame (wrongly) applied to those who can’t. There is a massive difference between not wanting to and not being able to. I don’t disagree that we need to get to the causes of the causes of poverty and child hunger – absolutely right! But this will take a generational, focused, gargantuan and sustained effort and will involve us turning the tide on: Adverse Childhood Experiences, an unbalanced and unequal education system, spiritual and psychological degradation, ingrained and systemic racism, white privilege and abusive patriarchy, county lines, unaffordable land and housing (both to buy or rent), poorly paid work, a broken justice system (over 300000 children have at least one parent in prison) etc. We should definitely work on all of this! And as we do it will enable people to be able to take more responsibility and make more positive choices – I’m all for that. Unfortunately at present, the reality is that there are far fewer real choices available for people living in our most economically deprived communities. This is not about either/or – it’s about both/and. So, in the mean time, whilst we’re working on the causes of the causes, perhaps we could also guarantee that we don’t perpetuate the cycle further and ensure children are fed?
  2. The idea that by the state stepping in it encourages dependency, fecklessness and laziness is actually ridiculous. State intervention to provide for the hungry would actually show that we have a society and a government who care deeply for people who are struggling and having a hard time. It is one of the great debates about the role of the state, but the sad reality is that charity alone, simply won’t cut it. We need a state (be that city, regional or national – preferably all), that acts as a safety net for those who are finding life the hardest. Rashford puts it best: “……since March, 32% of families have suffered a drop in income. Nearly 1 million have fallen off the payroll. This is not dependency, this a cry for help. There are no jobs!! 250% increase in food poverty and rising. Nobody said this was simple…” Until we fix the causes of the causes, we are going to need to ensure we have appropriate interventions to the difficult realities so many in our communities face. Perhaps this might include children being fed through the holidays?
  3. Despite the ‘positive changes’ to the benefits system, with more people in work, we had rising poverty levels even before the pandemic, with more children in poverty, (worsening over the last ten years) and now we have massive job insecurity, higher
    Rise in use of Food Banks – Trussell Trust

    unemployment and we’re heading into a recession. At such a time, to imply those benefits are enough, when we know that the use of foodbanks (which are supposed to be a temporary measure) is rising, is somewhat short-sighted. I have heard so many testimonies of families who are on the ropes. Holiday food vouchers are a life line. However good you might think your benefit system is, when families are telling you they are having to choose between fuel and food as we head into winter, perhaps we might want to think about how we ensure children are fed? After all, nutrition is one of the key building blocks of a healthy and well child.

  4. It is simply inhumane to ask the poor to fit the bill of the ill thought through spending of public money over the previous several months. There have been some VAST pay outs (which will indebt the very children the government are refusing to feed) to many companies, with clauses protecting them should they not deliver on their contracts, (which is lucky for them, because they have failed, badly)….and yet we can’t find the money to ensure that children are fed. One might wonder whose side the government is on.

 

I make no secret of the fact that I am personally deeply motivated by the politics of Jesus. There are two really clear things that he had to say on the issue.

 

  1. “I have come to preach good news to the poor” (Luke 4v18-19) – and he backs this up by stating that He will restore ‘Jubilee’ – this is a radical economic redistribution of money and resources, to the poor, to combat greed and bring things back onto a level playing field.
  2. “Let the children come to me, for to such belongs the Kingdom of Heaven” (Luke 18v16) – Not only are we to care for children, because they are important – we’re supposed to become more like them (Matthew 18v3)!

 

In other words, if the politics of Jesus are to be taken seriously (and it seems that many conservative voters and MPs profess a ‘Christian’ faith), let it be noted that according to the Christian faith, the poor, the hungry and children really matter to God! And yes – there is space for the church, other faith organisations, charities, communities and local leaders to step into the gap and ensure children are fed, despite the government’s response – but there is also a ‘prophetic mandate’ to challenge injustice and hold leaders to account. The truth is that the need is great – 1 million children across the UK will be hungry over October half-term – they don’t want this to be ‘relooked at for Christmas‘ – they want their bellies fed now. The national government’s arguments fall flat. While children go hungry, they find themselves defending their senseless ideologies and punishing the defenceless. They urgently need to change their minds!

 

 

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If We Want to ‘Level Up’ We Must Change The Funding Formula

“Talk is cheap” – my Dad used to say this to me, if I told him I was going to do my chores but didn’t do them. It was a fair challenge to my teenage self! It’s ok to have good intentions, but if we don’t act to back up what we say, then our words are meaningless. One of my most recent blogs explored what we can do to tackle poverty and health inequalities. One of the things I didn’t focus on, but which deserves a blog all to itself is the inequality caused by and the social injustice which is perpetuated by the funding formula used within the NHS. I will demonstrate, using a few examples why this formula is so antiquated and suggest that the ‘Morecambe Bay Formula’ which we have developed might be a better model for the future if we want to put our money where our mouth is! I’m sure with Boris Johnson’s ‘levelling up’ agenda, that the time has come for us to take this seriously.

 

The current Carr-Hill Formula takes into consideration various factors. Generally it’s what we call a weighted-population formula and distributes money and resources according to various complex factors but puts insufficient weighting on the issue of deprivation. What this means in practice is that wealthier areas (like the South East) have significantly more money, per head of population, spent on them than areas (like the East Midlands or the North West), where poverty rates are much higher and health outcomes are significantly worse.

 

Let me give you two examples from here in Morecambe Bay as to how that makes little or no sense if we are serious about levelling up.

 

Here are a couple of graphics showing how life expectancy changes along two different bus routes around Morecambe Bay (recognising that these are averages within these towns and are significantly worse within some more localised wards):

You can see the stark differences in life expectancy between people who live in Barrow-in-Furness and those who live in Ambleside, or those who are in Heysham compared to those in Levens. People in our areas of 10-20% lowest Index of Multiple Deprivation (IMD) are dying 10-15 years earlier than their counterparts in our wealthiest wards. Surely we care enough about this to want to change things?!

 

So, our team did a little exercise in which we thought together about how we might spend £500k, if we were going to try and ‘level up’. Our Bay, is broadly divided into three districts. The Furness Peninsula, South Lakeland and Lancaster District (which is basically North Lancashire). We divided the area up according to the lowest 10% IMD and distributed the money accordingly, knowing the kind of projects we could invest in to make a difference to people’s life expectancy and wellbeing. The results were stark! We found that out of £500k, we would spend around £232,000 in the Furness area (predominantly wards in Barrow and Millom), £267,000.50 in Lancaster District (predominantly Morecambe/Heysham and some wards of Lancaster) and just under £500 in South Lakeland! £500 out of half a million! But that’s how stark the differences are in our Geography of around 1000 square kilometres. When we then changed this formula to be based on our lowest 20% IMD areas, the South Lakes still only ended up with just over £1000.

 

We’ve also recently done a review of how many people in each area are living with Long Term conditions. What is very interesting is that in two almost identical areas in population size (Lancaster and Morecambe), but one with significantly more areas of increased deprivation (Morecambe), people in that area have a higher number of Long Term Conditions (LTCs). However, when it comes to the allocation of resources into the Primary Care Networks, working in these two areas, this is done on the size of the population, not the complexity of what those populations are dealing with. So, even though there are far more people living with multiple LTCs in Morecambe, compared to Lancaster, they are both allocated the same number of staff through the PCNs to deal with their relative problems.

 

This means that areas like Morecambe and Barrow are missing out twice over. They are not getting the money into their areas in the first place to allow them to level up on the ’causes of the causes’, as Sir Michael Marmot puts it, – i.e. they are not able to get into good preventative public health AND they are not given a fair weighting when it comes to helping those who are already living there with significantly more complex health needs. This means teams working in places like Morecambe can find it harder to recruit and their teams can suffer easier burn out, or are simply unable to provide the help to their communities that is needed. We know that economically poorer areas have higher populations of BAME citizens also, which is vital to understand if we’re serious about ‘Black Lives Matter’.

 

This injustice needs to stop if we are serious about tackling health inequalities. Talk is cheap. It’s time to put our money where our mouth is. We can’t just talk about levelling up, we must do it! We need action and that action needs to take the form of a recalculated funding formula, which ensures that the communities that need the most help are able to get it. When it comes down to it, I’m a pragmatist. There are pockets of poverty, even in our wealthiest areas and issues like frailty can make the provision of care more expensive (though one could argue that in poorer areas, we’re dealing with frailty 10-20 years before it is seen in wealthier populations). So…..we need to do two things:

 

  1. We need to change the way funding is given through the Primary Care Networks to ensure that those who have the greatest task, get the greatest help. This needs prioritising by the national leadership team.
  2. We need to ensure that we create a funding formula from the National  Team into the Integrated Care Systems in each of the regions and then within each ICS that recognises the complexities we’re dealing with when trying to level up. The funding formula based on IMD (either lowest 10 or 20%) is indeed quite extreme – perhaps it needs to be. Perhaps a more realistic formula is to to weight it 50:50, with half of it calculated according to the lowest 20% IMD and half according to the Carr-Hill Weighted formula. This has gained broad support across the board in our part of the world. We call it the Morecambe Bay formula (though it is with huge thanks to Mark Wight and Anji Stokes!). We believe it is far more socially just.

 

 

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