Welfare Reform, health and the NHS in Scotland Kate Burton NHS Lothian and Scottish Public Health...

Welfare Reform, health and the NHS in Scotland

Kate BurtonNHS Lothian and Scottish Public Health

Network

"the most ambitious, fundamental and radical

changes to the welfare system"

Reform of the welfare system

• Welfare benefits system is too complex

• Welfare benefits system is too expensive (cuts totalling £18 billion 2011-14)

‘...the only thing that really beats poverty, long-term, is work’

Work, wellbeing and health

• Work is generally good for health and wellbeing

• Returning to work can lead to rapid improvements in health

• You don’t have to be 100% fit to work• Good work is safe, fair, secure, fulfilling,

supportive and accommodating

‘No longer will it be possible to be better off on benefits than in work’

Reform of the welfare system

Employment Support Allowance Tax CreditsConsumer Price Index Housing Benefit

Local Housing Allowance Benefit CapsChild Benefit Income Support Council Tax

Social Fund Sure Start Maternity GrantDisability Living Allowance

Universal Credit Passported Benefits

Housing benefit: under occupancy rules

• 82,500 households affected, 80% disabled

• 68,500 under-occupying by one bedroom; only 20,000 one bedroom properties available

• Impact of debt on physical & mental health

• Impact of homelessness on health• Impact of DHP on primary care

Disability Living Allowance / Personal Independence Payment

• Timescale• Application process • Reassessment process• 36% to lose out

“Our reforms are ushering in a new culture of conditionality and the claimant commitment lies at the heart of this”

‘We’re all in this together’ George Osborne

The Hardest Hit 

• Workless households and those in low paid work of more than 16 hours per week

• Households with children• Lone parents (90 per cent of whom are

women); possibly also women in couples• Larger families• Disabled people and those with long term

health conditions

‘…the welfare cuts (and in real terms, it is a cut) does not just affect some mythical group of immoral workshy scroungers. It affects people who are working – who are, in the political lingo, doing the right thing and playing by the rules. Poorer people are facing destitution, perhaps a decade of destitution, felt by future generations.’

Julia Unwin, chief executive, Joseph Rowntree Foundation (2012)

Challenges for the NHS – primary care, diagnostic testing &

prescribing• Increase in health inequalities• Poorer mental health• Increased cardiovascular and respiratory

illness• Poorer nutrition and increases in diabetes,

arthritis and cancer• Child protection & violent crime• Sexual health

I cannot address medical issues as I have to deal with the patient’s agenda first, which is getting money to feed her family and heat her home.’

(GP’s at the Deep End, 2012)

Employability actions

Strategy dev & service

delivery

Workforce planning & support

Partnership working

Financial assessments

& referral

Staff training & awareness

Monitor impact

Thank Youkate.burton@nhslothian.scot.nhs.uk