In this webinar we'll examine the role that poverty plays in healthy ageing, and hear what organisations are doing to address this major determinant of health inequality.

1. Centre for Ageing Better
ageing-better.org.uk
Health inequalities:
Healthy ageing webinars
In this webinar we'll examine the role that
poverty plays in healthy ageing, and hear what
organisations are doing to address this major
determinant of health inequality.
Broadcast live on
14 January 2021, from 2pm GMT

2. ageing-better.org.uk
Alison Giles
Associate Director for Healthy Ageing
Today’s Chair
Health inequalities: Poverty
14 January 2021

3. Centre for Ageing Better
A consensus on healthy ageing
– Co-created by organisations across national and local
government, charity and voluntary organisations, public
health, academics and the NHS.
– Launched in October 2019
– Signed by over 120 organisations
https://www.gov.uk/government/publications/healthy-ageing-
consensus-statement

4. Centre for Ageing Better
Healthy Ageing: five principles
1. Putting prevention first and access to early diagnosis
2. Creating opportunities for people as they age to make a
contribution to society
3. Supporting good homes and neighbourhoods
4. Narrowing inequalities
5. Tackling ageism

5. Healthy Ageing
The Ageing Society Grand Challenge:
People can enjoy at least 5 extra healthy,
independent years of life by 2035, while
narrowing the gap between the experience of
the richest and poorest

6. 7
Average life expectancy at birth (years) in England, 2016-18
Source: Life expectancy (LE), healthy life expectancy (HLE) and disability-free life expectancy (DFLE) at birth and age 65 by sex, UK,
2016 to 2018. Available at
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/datasets/healthstatelifeexpecta
ncyatbirthandatage65bylocalareasuk

7. 8
The gap in disability-free life years
Source: ONS
0
10
20
30
40
50
60
70
80
90
100
Males - least deprived Males - most deprived
Years of life
17 years
gap
0
10
20
30
40
50
60
70
80
90
100
Females - least deprived Females - most deprived
Years of life
16 years
gap
Disability free years
Poor health

8. Centre for Ageing Better
The gap in healthy life expectancy between rich and poor
Source: Based on WHO Active Ageing: A Policy Framework. 2002
53 69
Childhood
Growth &
development
Early and mid adulthood
Maintaining highest possible
level of function
Later Life
Maintaining independence
and preventing disability
Age
Disability threshold
Functional
capacity

9. Centre for Ageing Better
Disparity by wealth

10. Centre for Ageing Better
How does poverty impact on health?
Individual Place
Poor housing condition Air pollution
Food poverty Low access to green/blue spaces
Stress - insecure job or home Low access to fresh produce
Fuel poverty Low access to cultural resources
Digital poverty Low access to primary healthcare
STRESS Suppressed labour market

11. ageing-better.org.uk
Approaches to Poverty Reduction
in Greater Manchester
Simon Watts, Public Health Registrar
Health inequalities: Poverty
14 January 2021

12. Centre for Ageing Better
Approaches to Poverty Reduction in
Greater Manchester
Simon Watts
Public Health Registrar, Greater Manchester
Simon.watts1@nhs.net

13. Introduction
• My background
• What this presentation will cover:
• GM context – poverty and health and healthy aging
• Summary of current approaches to prevent and mitigate poverty in Greater Manchester.
• Not a systematic review of all the ongoing work to reduce poverty in Greater
Manchester; much more work going on at local level.
Simon Watts
Public Health Registrar, Greater Manchester
Simon.watts1@nhs.net

14. Greater Manchester Context
• Deprivation and Healthy Life Expectancy
• 12 of the top 100 most deprived areas in the UK are in Greater Manchester (IMD).
• Healthy life expectancy by ward ranges between 49.6 years and 73.
• Estimated 157,000 fuel poor households in Greater Manchester, 13% (ONS); in a
number of areas fuel poverty as high as 40%. Strong links to poor health.
• Growth in insecure employment/zero hours contracts – impact on future pensions
• Debt
• Pre-Covid, GM insolvency rates were at 2008 recession levels.
• Covid-19
• 99% increase in UC claimants since Dec-19 in GM (HMRC). Inequalities attached to
this; the gap between poorer and richer areas is getting bigger.
• One in three families are getting into debt as a result of the pandemic (Turn2us).
• Impact on health
• Poverty/income as a determinant of health
• Poverty linked to isolation
• 41% of most deprived population account for 50% of A&E attendances in GM.
• Governance and GMPA’s role
“Everyone’s depressed as well because you’re just living
to get through, to the last day, you’re not actually
having fun or having a nice life at all”

15. Geographic Inequalities
Rate of UC Claimants per 1,000 of population across Rochdale
UC usage since Covid-19 growing
faster in some (lower income)
areas of Rochdale than other
(higher income) areas.
In some LSOAs >25% of
population are on UC.
Increasing proportion of males
on universal credit
Rising inequalities between low
and higher income areas.
Implications going forward?
Younger people more impacted,
but older people too.

16. Greater Manchester Context
“Everyone’s depressed as well because you’re just living
to get through, to the last day, you’re not actually
having fun or having a nice life at all”
• Deprivation and Healthy Life Expectancy
• 12 of the top 100 most deprived areas in the UK are in Greater Manchester (IMD).
• Healthy life expectancy by ward ranges between 49.6 years and 73.
• Estimated 157,000 fuel poor households in Greater Manchester, 13% (ONS); in a
number of areas fuel poverty as high as 40%. Strong links to poor health.
• Growth in insecure employment/zero hours contracts – impact on future pensions
• Debt
• Pre-Covid, GM insolvency rates were at 2008 recession levels.
• Covid-19
• 99% increase in UC claimants since Dec-19 in GM (HMRC). Inequalities attached to
this; the gap between poorer and richer areas is getting bigger.
• One in three families are getting into debt as a result of the pandemic (Turn2us).
• Impact on health
• Poverty/income as a determinant of health
• Poverty linked to isolation
• 41% of most deprived population account for 50% of A&E attendances in GM.
• Governance and GMPA’s role

17. GM Approach to
Preventing and
Mitigating Poverty
Local Authority Strategies
to Prevent/Mitigate Poverty
Poverty in All Policies
• Socio Economic Duty
• Health impact assessments…
Welfare Reform
• Coordinating group
• Awareness Raising e.g.
Pension Credit Campaign
• Strengthening local welfare
support
• MECC
Data and Intelligence
GMPA Poverty Monitor
Coordinated response
to Food Poverty –
Action Plan
GM Living Wage Campaign
Targeted health
interventions e.g.
Focused Care, targeted
interventions at older
working age
Focusing on prevention
in debt and welfare
advice services
Fuel Poverty
e.g. GroundWork
Resident led change –
Poverty Truth Commissions
(6 across GM)
Redesigning
employment support
for older age groups &
age friendly employers

18. Closing Comments
• There is lots of positive work at a local and regional level, but a degree of inconsistency between
boroughs.
• Is this the case in your areas?
• How can poverty be put at the heart of the agenda locally, particularly the healthy aging agenda?
• There could be a role for stronger coordination across the GM footprint to improve consistency –
balanced against local solutions for local need.
• How could coordination of poverty prevention and mitigation efforts be better coordinated in your area?
• Poverty and income deprivation is core to health and to healthy aging. Measures to prevent and
alleviate poverty need to feature in all aspects of local (and national policy) – poverty in all policies.
There is a strong moral case for this, but also a health economic one.
• Thoughts, feedback, questions?
Simon Watts
Public Health Registrar, Greater Manchester
Simon.watts1@nhs.net

19. Our vision is of a Greater Manchester free from poverty where all residents can realise
their potential and access the benefits of living in a diverse and vibrant city region.
Greater Manchester Poverty Action (GMPA) is a not-for-profit organisation that
works to address poverty across Greater Manchester.
We convene and network organisations from public, private and VCSE sectors, and
people with lived experience of poverty, to foster collaboration and innovation and to
maximise the impact of efforts to address the underlying causes of poverty across
Greater Manchester. We equip stakeholders with the knowledge they need to tackle
poverty. We carry out research and advocate for changes in policy at a local and city
regional level and sometimes at a national level to address the structural and systematic
causes of poverty.
There are three strands to our work: Policy and research, programmes and network
support.
https://www.gmpovertyaction.org/
contact@gmpovertyaction.org

20. ageing-better.org.uk
The role that poverty plays in
healthy ageing
Neil Munslow MBE, Service Manager
Health inequalities: Poverty
14 January 2021

21. Health inequalities: healthy ageing webinar
The role that poverty plays in healthy ageing
14 January 2021
Neil Munslow, Service Manager: Active Inclusion

22. What I’ll cover
• Dr Alison Giles request: “tell the story about what a council is able to do to prevent
& alleviate poverty & then describe Newcastle’s journey. In public health we
acknowledge the impact of poverty on health but don’t often hear anyone speaking
practically about trying to address poverty systematically or across the life course”
• And, what are the “thought processes & the levers available to a council to respond
to the challenge that a person born into a disadvantaged household in England may
only spend 53 years of their life in good health, free from a disability?”
• Local government’s in responding to the Consensus Statement on Healthy
Ageing principle of putting prevention first to ensure timely access to services &
support when needed to help to narrow inequalities

23. Newcastle: economic context, why responding to poverty matters
Newcastle is in the 20% most deprived English
local authority areas (ranked 53/326)
19.9% of households in Newcastle are workless
(compared to the UK average of 14.5%)
29.1% of dependent children in Newcastle live
in low income families (compared to the UK
average of 19.9%)
home to the UK’s largest foodbank
Source: Newcastle’s submission to the UN
Special Rapporteur, 2018

24. Our challenges & responses
An estimated annual loss of £119m in
working age benefits by the end of
2025-26
An estimated £345m reduction in
Newcastle City Council’s budget by
2023, due to government cuts &
increasing Coronavirus cost pressures
The roll out of Universal Credit was
65% complete in Newcastle in
September 2020, compared to 57%
across Great Britain
Your Homes Newcastle (YHN) rent
arrears by March 2020 (£3.41m increase
from 2012)
Residents on Universal Credit – 12,840
more on Universal Credit a 56%
increase between Mar 2020 & Nov 2020
35,151
£119m
£345m
£5.20m
?
residents helped to secure £28.6m of
welfare benefits
Known responses in 2019-20 *
3,745
22,920
3,853
cases of homelessness prevented
residents received debt advice
50
awards for discretionary funding (Crisis
Support Scheme, Discretionary Housing
Payments & Supporting Independence
Scheme)
69,199 visits to Active Inclusion Service
website pages
3,779
YHN evictions (75% decrease since 2008)
72%* 622 instances of people found rough
sleeping April 2020 to Jan 2021 (2,421
instances July 2019 to Mar 2020)

25. Active Inclusion Newcastle partnership approach to
homelessness prevention & financial inclusion
Our aim is to make it everyone’s business to prevent homelessness & financial exclusion at
the earliest opportunity
In 2013 we began our Active Inclusion Newcastle partnership approach to respond to
meeting the increased demand for advice, support & accommodation created by the welfare
reforms & localism, with the reduced resources increased by austerity.
Built on our strengths: political leadership, Your Homes Newcastle & a culture of prevention &
compassion, to better support residents to have the foundations for a stable LIFE:
● Somewhere to Live – a home ● An Income – benefit entitlement
● Financial inclusion – life without excessive debt ● Employment – inclusive growth

26. Analysis of the role of local government in relieving & preventing
homelessness & financial exclusion
FEANTSA: homeless prevention role of cities
• Better data collection
• Increasing access to affordable housing
• Delivering integrated services
• Investing in prevention
Just Fair: tackling socio-economic inequalities locally
• Visible leadership
• Creating a cultural shift – changing expectations eg
adopting the socioeconomic duty
• Meaningful impact assessments
• Using data effectively
• Engaging with residents, civil society & voluntary &
community sector organisations
Heriot-Watt: homelessness prevention in Newcastle
• Partnership driven
• Early prevention beyond statutory 56 day duty
• Proactive: at policy level maximise contact
opportunities. At the practice level in identifying &
engaging at-risk households
• Data & evidence informed
Facilitators
• Political leadership
• Accommodation & support: 27,000 council houses &
70 support staff , 729 hostel rooms, floating support
• Innovation: multidisciplinary team, JCP partnership,
case finding
Could local government govern? Rethinking the role of councillors Prof Colin Copus
The right to convene to meet place-based aims. Councillors must work by negotiation, compromise, coalition &
alliance building & above all by exerting as much influence as possible over those bodies that they seek to draw
into some shared vision of their locality, or simply to get a single decision made that fits with the council’s own vision

27. Visible leadership – inclusive, transparent, evidential & accountable
Newcastle City Council’s Cabinet champions tackling socio-economic disadvantage & communicates
clearly & consistently why it is a priority
Guardian interview with Councillor Joyce McCarty, Deputy Leader of the Council (21 March 2018)
“Labour-run Newcastle city council has been developing
a programme to prevent people losing their homes since
2013 as part of its ambition to be a homelessness-free
city. Carefully stitching together a comprehensive early
intervention safety net, bringing together a wide range of
local agencies, including Jobcentre Plus, to work closely
to help households at risk of losing their home. The
guiding principle is to stop debt & poverty escalating into
a homelessness crisis.”

28. Ways of working to realise the vision of making preventing homelessness
& financial exclusion everyone’s business
• Understand & care about the local impact – for individuals, organisations, communities & the city, aggregating
case-based evidence. Newcastle Gateway matches 24,857 residents with 77 services & has 531 users
• Align budget processes to support vulnerable residents to prevent crisis – maximising the value of the
£11m+ collective investment in accommodation, advice & support
• Develop citywide consensus & partnership responses – 134 services & organisations participate in our
quarterly forums & we publish quarterly reviews on financial inclusion & homelessness prevention to facilitate our
collective learning framework – local government's convening role
• Provide infrastructure support – information & workforce development to help non-specialist partners in
homelessness prevention & financial inclusion to identify risk & to prevent crisis
• Provide proportionate partnerships, pathways & protocols – to improve consistency, governance & practice
• Maximise the value of touch points & trigger points
• Target support to prevent crisis & catch residents where we fail to prevent crisis
• Provide systematic exception reporting & feedback loops – to understand why we haven’t prevented
homelessness or financial exclusion, e.g. due to performance, policy or commissioning, & then problem solving
• Consider the balance of individual, systemic & structural causes of exclusion – the role of the local state

29. Targeted offer for high
volume risks
Targeted offer to
support staff
supporting those
in crisis Exception reports:
learning from crisis to
identify prevention
opportunities
Exception reports:
learning from crisis to
inform primary prevention
activities
Exception reports:
informing primary
prevention activities
Crisis activities – catching residents if we fail to
prevent homelessness & destitution
Secondary prevention activities – targeting specialist
advice & support to vulnerable residents
Timely referrals when advice &
support fails to prevent crisis
Secondary prevention examples in 2019-20: 30,601 residents advised, 3,745
cases of homelessness prevented, 23,198 residents helped to secure £28,991,470,
3,853 residents received debt advice, 345 Cherry Tree View preventative outreach
cases, 1,172 non emergency admits to supported accommodation
Crisis examples in 2019-20: 312 individuals were
found sleeping rough, 50 YHN evictions, 451 admits
to emergency beds, 216 households accommodated
in Cherry Tree View to meet statutory duties
Primary prevention examples 2019-20: 69,199
website visits, 3,721 information subscribers, 860
people trained,134 partners
Visualising our Active Inclusion Newcastle partnership approach
Primary prevention activities – adapting services to identify & prevent crisis with protocols, reviews, information, training & support –
systematic evidence collection & reviews to inform policy & commissioning:
www.newcastle.gov.uk/financialinclusionforprofessionals & www.newcastle.gov.uk/homelessnesspreventionforprofessionals

30. Homelessness
Prevention Forum
Quarterly
Chair: Cabinet member
for Housing
Financial Inclusion
Group
Quarterly
Chair: Deputy Leader
Cross Council
Migration Group
Bi-monthly
Chair: Service Manager:
Active Inclusion
Strategic
partnerships
Delivery
partnerships
Newcastle
Advice Compact
Monthly
Private Rented
Liaison
Monthly
(internal);
Quarterly
(external)
Case
coordination
Supported Housing
Move On
Weekly
Complex Case
(Housing)
Panel
Weekly
Temporary Accommodation
Progress
Weekly
AIN partnership arrangements – supporting integrated responses
Welfare Reform Board
Quarterly
Chair: Director of
Resources
North of Region
Homeless
Operational
Group
Bi-monthly
Sustaining Tenancies
As required
Food Poverty
Group
Quarterly
Jobcentre Plus
Homelessness
Prevention liaison
Bi-monthly
Street Zero
Board
Quarterly
Chair: Bob Eldridge
Mental health
and housing
forum
Monthly

31. “Upstreaming” homelessness prevention & financial inclusion – using positive
examples of early intervention touch & trigger points
• YHN Advice & Support – 1,231 tenants’ potential homelessness prevented in 2019-20 by YHN Advice & Support
Workers working to the Sustaining Tenancies Protocol – money advice at the start of the process
• YHN Refugee move-on team – 348 referrals from Home Office G4S asylum contract in 2019-20, with only 10
requiring temporary accommodation
• YHN Young People’s Service – 137 16 & 17 year olds presented as homeless in 2012-13, down to 36 in 2019-20
• Alignment of DHP with advice & support – 506 households awarded a DHP identified in 2019-20 to facilitate
aligning DHP conditionality to advice & support services to respond to those conditions & reduce residents’ risk of
homelessness
• Cherry Tree View preventative outreach – 345 households in 2019-20 identified at risk of requiring emergency
accommodation provided with support in their home by specialist Housing Support Officers from the council’s
statutory emergency homeless accommodation service to prevent them requiring emergency accommodation
• Lower benefit cap – targeted proactive preventative support for the households affected to help mitigate the
impact of reduced income through income maximisation, debt & budgeting advice & support, housing advice &
employment support
• Homelessness Prevention Trailblazer pilot with Jobcentre Plus – 868 referrals from Jobcentre Plus to
partners from June 2017 to March 2020 for claimants at risk of homelessness

32. Examples of upstream homelessness prevention & financial
inclusion activities & outcomes
Strategic level
• bi-annual reporting on Newcastle’s responses to the Government’s welfare reforms to Newcastle
City Council Cabinet
• informing local policy (eg the corporate debt review focused on Council Tax & rent arrears, &
Housing Benefit overpayments; & the Council & Your Homes Newcastle leading the wider housing
sector to develop an approach of having no evictions into homelessness
• informing national policy eg HM Treasury on the Government’s Breathing Space scheme, the House
of Lords inquiry into the economics of Universal Credit, the Local Government Association’s on
delivering financial hardship support schemes, & the Cabinet Office on fairness debt management
Delivery level
• the Council’s Welfare Rights team supported 12,085 residents aged over 65 years old to secure
£23,263,586 of unclaimed welfare benefits between 2015-16 & 2019 (including Attendance
Allowance, Pension Credit & Carer’s Allowance)
Case level
• Sustaining Tenancies, Complex Case (Housing) Panel, Active Inclusion multidisciplinary team

33. 2018 -19 2019-20 2020-21 (Q1
& Q2)
1. Maximise income & respond to the welfare reforms
Clients advised 21,670 23,198 10,315
Benefit gains £31,171,014 £28,991,470 £13,631,559
Digital skills courses (sessions /
people attended)
98 sessions,
459 attended
77 sessions,
412 attended
No sessions
ran
CAN Help to Claim Service –
Digital assistance with UC claims
N/A 1,157 593
2. Support residents to manage their money, increase financial resilience & reduce harmful debt
Clients advised 4,916 3,853 1,154
Debts written off £1,963,639 £1,365,510 £362,256
3. Support residents to train, gain & remain in employment
Residents supported into
employment, voluntary work or
630 329 89
Our work to promote financial inclusion – ongoing service
delivery throughout lockdown

34. 2018-19 2019-20 2020-21 (Q1
& Q2)
4. Promotion of affordable credit as an alternative to high interest credit or loan sharks
Moneywise Credit Union –
number of members across their
common bond area
9,782 10,590 8,879
Loans granted 2,382 2,224 648
5. Reduce fuel poverty
Energy Services – referrals
received
521 588 217
CAN – clients advised 1,081 1,285 319
6. Tackle food poverty
West End Foodbank – people
fed
Not available Not available 26,232
Our work to promote financial inclusion – ongoing service
delivery throughout lockdown

35. Identifying
opportunities
to better
target support
to private
rented
tenants
Programme
to end homelessness in
Newcastle
Transitions
programme
The Council &
YHN leading an
approach of
having no
evictions into
homelessness
Rapid
rehousing
pathways &
Emergency
Housing Panel
learning
Coordinated
solutions
for named
people who
are sleeping
rough
Newcastle’s Homelessness & Rough Sleeping Strategy & coronavirus
(COVID-19) recovery next steps – challenges & opportunities
Increased
moves to
suitable &
sustainable
homes
Reduced crisis
homeless
presentations

36. X has got us out of a whole lot that I didn't think I
could get out of
Just knowing that there is people
out there willing to help
She's like a fairy godmother &
everything was in order
It'd all been building up & building up & it was
getting me upset & now it's not
I'm on top of everything
now
Recognition of our approach from the residents we serve
I would be dead if it wasn't for x, you
probably can't put that in your box can
you?

37. Relative successes & absolute failures
Heriot-Watt: Homelessness Prevention in Newcastle: Examining the role of the ‘local state’ in the
context of austerity & welfare reforms
“the clear message is that Newcastle has been a consistent high performer in terms of the volume of
recorded (homelessness) prevention & relief activity undertaken.
Newcastle also received the highest classification, a Gold Award,
in the World Habitat Awards 2020 for our long-term approach
to homelessness prevention. The judging panel said:
“This is a really impressive project, especially when you consider the deprivation locally & the cuts they
have faced. It highlights local political commitment & leadership to continue to take an active & thorough
approach – while working with other agencies – to prevent homelessness. There are things that others
can learn from this project, in particular linking housing, homelessness, the voluntary sector, social care &
welfare – there’s no way you can end homelessness unless you make those links.”

38. Questions, discussion & websites to find out more
Newcastle’s Homelessness & Rough Sleeping Strategy 2020-2025
For information about homelessness prevention, see:
www.newcastle.gov.uk/homelessnesspreventionforprofessionals
For information about financial inclusion, see:
www.newcastle.gov.uk/financialinclusionforprofessionals
Email: activeinclsuion@newcastle.gov.uk

39. Centre for Ageing Better
ageing-better.org.uk
Health inequalities:
Healthy ageing webinars
Thank you for watching