CHILD POVERTY LOCAL ACTION REPORT - Aberdeenshire
CHILD POVERTYLOCAL ACTIONREPORTAberdeenshireJune 2019
Child Poverty Local Action Report, AberdeenshireJune 2019INTRODUCTIONAberdeenshire remains a relatively affluent area of Scotland. However, pocketsof deprivation and rural isolation nevertheless exist. The Scottish Index of MultipleDeprivation (SIMD) identifies different domains of multiple deprivation acrossScotland, in data zones (small areas of around 500-1,000 people) and Aberdeenshirehas six data zones in the most deprived 20% in Scotland. Three of these are within the10% most deprived. These are found in Peterhead and Fraserburgh in the North ofAberdeenshire. Some areas within Aberdeenshire reflect higher than Scottish averagelevels of infant mortality and childhood accidents.2.1% of Aberdeenshire’s population reside in these six zones and are seven times morelikely to be employment deprived compared to the average for Aberdeenshire. Fiveout of the six zones have the most severe household overcrowding problem for alldata zones in Aberdeenshire. All six data zones have the lowest pupil attendance ratesfor school-aged pupils of all data zones in Aberdeenshire.In 2018/19 the Aberdeenshire figures show the following -Approximately7,023children andyoung people areliving in poverty2,803households earn lessthan 60% of the medianhousehold income.2,556children receivingfree school meals.In Aberdeenshire people are living in poverty due to low wages, high living costs, lackof accessible affordable childcare, transport and limited opportunities. Research acrossAberdeenshire confirms that those who are not working overwhelmingly want towork, but face barriers to employment. Principally these are ill-health, transport andchildcare, but also caring responsibilities for family members. Some parents worryabout the impact poverty has on their children, particularly that they may be bulliedbecause of the circumstances in which they live. Parents also report that they canalso feel stigmatised when accessing services which can result in reluctance to accesssupport in future. Children living in poverty frequently report feeling excluded andembarrassed, citing it as a key source of unhappiness, and worry about their parents.The Aberdeenshire CPP commissioned a report that builds a local picture of child poverty:“Tackling Child Poverty in Aberdeenshire: lessons from local voices” (2018)The Poverty Alliance, Scottish Poverty and Inequality Research Unit, Glasgow Caledonian University,2
Child Poverty Local Action Report, AberdeenshireJune 2019ABERDEENSHIREPRINCIPLESHELPING TOMEET THETARGETS OF THECHILD POVERTY(SCOTLAND) ACTThe Child Povery Action Plan has been developed byAberdeenshire Council, NHS Grampian and widerpartners within the CPP. Action to address Child Povertyis also one of the Aberdeenshire LOIP priorities.Our approach to tackling Child Poverty focusseson addressing the root causes and building people’scapabilities through income maximisation, employability,improving quality of life, helping families manage theimpacts of poverty and promoting positive life chances.It is important the voices of those with lived experiencesare not just heard but their views construct futurestrategies and the Aberdeenshire Child Poverty ActionPlan, as these families are key to the delivery of the 4overarching goals which are highlighted in our ChildPoverty Action Plan: Preventing children on the margins of povertyfalling into poverty.Aberdeenshire Council,NHS Grampian and the AberdeenshireCommunity Planning Partnership (CPP) arecommitted to eradicating child povertyin our area by 2030. Reducing the number of children livingin poverty by moving those in poverty outof poverty. Protecting children living in poverty from itsmost adverse effects. Enabling children to live a poverty-freeadult life.3
Child Poverty Local Action Report, AberdeenshireJune 2019PROGRESS 2018/19Improving OutcomesChild Poverty is also a strategic priority for theAberdeenshire’s Community Planning Partnership. TheChild Poverty Action Plan has also been developed as aCommunity Planning Local outcome Improvement Plan.The full action plan is outlined in Appendix 1.34 Family Kitchen sessions delivered during the schoolholidays over Easter, Summer and October with 369attending - 134 adults and 235 children.Those with lived experience highlighted that the stigmathey feel when accessing services was the main reasonfor not seeking support. The Cost Of The School DayProgram was delivered in Stonehaven and will be rolledout to all areas of Aberdeenshire 2019 - 2021. It helpedpractitioners to better understand the unspoken needsof families to cover the various costs that come withtheir children’s educationOver the last 12 months the development of apartnership action plan on child poverty has beena priority for the lead group - Tackling Poverty &Inequalities, a partner group reporting to our CPP Board.It was agreed that the voice of lived experience shouldbe key in developing solutions and identifying areaswhich require development. To ensure the Action Planwas informed by those low income families, a researchproject was commissioned on behalf of AberdeenshireCPP Tackling Child Poverty in Aberdeenshire: Lessonsfrom local voices (2018). The outcomes of this researchand other available research and data contributed to thedevelopment of the principles, structure and focus of theAction Plan.The intention of the Child Poverty Action Plan is toimprove outcomes for all families living in poverty orat risk of living in poverty but the key emphasis will besupporting families where the risk of children living inpoverty is highest. The Plan outlines a range of actionsaddressing the three main drivers of child poverty: income from work and earnings; costs of living; income from social securityActions have been informed by the requirementsrelating to the LOIPs; the ambitions set out byScottish Government in Every Child, Every Chance aswell as priorities identified at an Aberdeenshirelevel, link in with economic development and inclusivegrowth; transportation; housing and homelessness;community safety; community learning; employabilityand community justice.Health and Children’s ServicesNHS Grampian has strongly acknowledged theexpectation placed on it to tackle child poverty incollaboration with local authorities, using communityplanning as a useful vehicle for identifying and carrying outactions. NHS Grampian is supporting the developmentand delivery of the Local Child Poverty Action Plans forAberdeen City, Aberdeenshire and Moray CommunityPlanning Partnership (CPP) areas for the reporting(financial) year period 2018 - 2019.Over the past 12 months we have identified variousopportunities for improvement, including in increasingthe up take of free school meals. A pilot project wasdeveloped and delivered to 557 pupils who were entitledto free school meals within the six northern Academies.An additional 1.20 was placed on pupils’ cards to allowthem to access a breakfast deal. The project increasedattendance, reduced lateness, increased the up take offree school meals and helped pupils to be more ready tolearn from the start of the day.One parent noted that “I suffer from depression &anxiety. Knowing that my children are getting breakfastand lunch really gives me a sense of relief, thank you”.NHS Grampian in providing health system leadershipin addressing health inequalities has supported theimplementation of Making Every Opportunity Count(MeOC) as an anchor approach. It is one of a number ofdrivers within the Grampian Clinical Strategy to increasecapacity within NHS Grampian to take positive actionthat enables people to live as well as they can, includingmaximising their income.Supporting low income families throughout the schoolholidays has been highlighted as an area of development.Over the last year Family Kitchen Projects, have seenNHSGs contribution to tackling child poverty inAberdeenshire is underpinned by a broader approachand cultural shift which provides a universal element at4
Child Poverty Local Action Report, AberdeenshireTier 1, the brief conversation, to ensure we normalisea holistic approach to people’s needs, including allaspects of income maximisation. The actions with theAberdeenshire Child Poverty Action Plan which NHSGrampian are leading on reflect this Learning hasindicated that across NHS Grampian there is a need tobuild capacity and capability taking account of the clinicalcontext and setting and the need to be sensitive to thecomplexities of people’s lives. Our approach thereforeis broad, supporting multiple tests of change to makeevery opportunity count across the public and thirdsectors. A number of these tests of change feed in toincome maximisation. In building capacity and capabilityacross Grampian, we are working with frontline clinicalcolleagues, including those in maternity services, todevelop and adapt MeOC in ways they believe will besthelp them to help their particular groups of patients,including pregnant women and their families.June 2019NHS Grampian will reinforce and promote theimportance of attending for antenatal care with the aimto increase the number of vulnerable mothers eligibleand in receipt of the Sure Start Maternity Grant (n.b.from summer 2019 SSMG will be known as the Best StartGrant). The Scotland Performs LDP Standard indicatesthat at least 80 per cent of pregnant women in eachSIMD (Scottish Index of Multiple Deprivation) quintilewill have booked for antenatal care by the 12th week ofgestation. Figure 1 indicates that in Aberdeenshire theLDP Standard was comfortably exceeded with 90.7%woman booked for antenatal care by 12 weeks gestationand 88.9% of maternities within the most deprivedquintile in Grampian are booked by 12 weeks’ gestation,lower than the less deprived quintiles.Fig 1: Percentage of maternities by week ofantenatal booking appointment, by HealthBoard; Year ending 31 March 2018PercentageLocally, there is growing understanding of the relevanceto patients, and importantly the feasibility, of briefwellbeing conversations and signposting in busy clinicalpractice. Referral to non-clinical services is increasing.Clinical colleagues have indicated that providing accessto patient stories would help them to help their patientswith issues such as income maximisation. To this end,within NHS Grampian’s innovative digital platform, NoDelays, clinician can send useful information on healthand well-being directly to patients by email. The sectionon income maximisation includes accounts by two localpeople of how they have benefited from accessing helpwith their money worries. These accounts illustrate theimportance of income maximisation alongside help withother personal and social challenges, and the positiveoutcomes of this support. These personal accounts canbe sent directly by clinicians to patients to encouragethem to take the next step.In these ways, we are buildinga sustainable approach to income maximisation throughour overall approach to MeOC. NHSG have taken stepsin increasing organisational capacity and capability toembed this work and continue to strengthen connectionswith partners to ensure patients, including parents andprospective parents, have the opportunity to accesslocal expertise on income maximisation.1009080706050403020100NHS Board of residence 10 Weeks10-12 Weeks13-15 Weeks16 WeeksNot KnownPrior to the launch of the Best Start Grant in December2019, NHS Grampian’s Health Improvement Team (wholead on Best Start Grant for NHSG), recognised thatthe potential beneficiaries of the grant along with NHS,local authority and third sector staff should have fulland accurate knowledge of who qualifies for, and howthey should apply for, the Grant. NHSG have worked inpartnership with the Local Delivery Relationship Leadsfrom Social Security Scotland (SSS) who cover Grampianto ensure clear communication and include SSS staff inrelevant meetings e.g. Best Start in Life Group.5
Child Poverty Local Action Report, AberdeenshireGrampian Community Midwives discuss the new grantwith all pregnant mums at their booking appointment.Early Years Practitioners are also encouraged to discussthe grant during contact time identified within theUniversal Pathway.June 2019promote the grant more widely. Scottish Governmentquarterly reports and data will be used to identifyareas of Grampian where applications for Best Start fallparticularly short of the number of mothers-to-be andfamilies identified as eligible. Additional promotion ofthe scheme in these localities will be used to improveuptake in each of the local authority areas. Once theBest Start Grant and Foods Scheme is fully rolled outand a mother-to-be can claim as soon as she recognisesshe is pregnant, BadgerNet Maternity will be used toensure the issue of income and possible sources ofsupport are discussed at the booking appointment andearly pregnancy.NHSG recognised that some of the information availableon the Best Start Grant wasn’t readily understood byall involved. Simple, concise notes were developed foruse by those who work with pregnant mums-to-be andfamilies to ensure accurate information was delivered toall potential beneficiaries.NHSG doesn’t currently receive information on thenumber of families eligible for Best Start grant. Officialstatistics are expected to begin August 2019 whichwill support targeting of effort to maximise uptake ofthe grant. However, Table 1 indicates the number ofBest Start Grant applications received and authorisedin Aberdeenshire compared to Aberdeen City, Morayand Scotland as a whole between December 2018 andFebruary 2019.Welfare Reform has been an important topic of discussionacross public sector organisations in Aberdeenshire inthe past year, especially relating to the impact on peopleexperiencing poverty. In late 2018, NHS Grampianproduced a report detailing the contribution of theNHS and the HSCPs across Grampian to mitigatingthe negative effects of welfare reform, in response toa request from the CMO in June 2018. It recognisedthat at least one of the target groups advised in ScottishGovernment’s revised Welfare Reform OutcomesFocused Plan – children in low income families – haspotential to overlap with actions to address ChildPoverty.Table 1: Best Start Grant Applications fromDecember 2018 to February 2019NHS Grampian’s Child Health 2020, A StrategicFramework for Children and Young People’s Health,additionally sets out how NHS Grampian will focusits efforts until 2020 to optimise children and youngpeople’s health. It encompasses many activities thatcontribute to child health, from education and earlyprevention through to tertiary healthcare services. Ittakes account of current national policy and initiatives,including Getting It Right For Every Child (GIRFEC) andthe Early Years Collaborative (EYC).Applications from Grampian currently have the poorestrate in Scotland of claims authorised (Scotland figureincludes 1,575 denied applications made from outsideScotland), but it is unclear if this is due to inappropriateapplications or poorly completed applications.The 5 key strategic priorities highlighted in theAberdeenshire Children’s Services Plan 2017 – 2020(Early Years, Mental Health, Children with a Disability,Substance Misuse and Wellbeing and CorporateParenting), produced by the Aberdeenshire GIRFECStrategy Group set out a wide range of actions whichare likely to make a significant contribution as well.NHS Grampian will continue to update NHS, localauthority, and third sector partners as the rollout of BestStart Grant continues. We will ensure this informationreaches all relevant staff and use social media to6
Child Poverty Local Action Report, AberdeenshireEXPERIENCESOF BEST START:June 2019Aberdeen Royal Infirmary and the money is claimedback from the NNEF. If a family are transferred toanother NNU, for example Glasgow, they continue toclaim from the NNEF through NHS Grampian. NNU areworking towards all maternity team members being ableto tell pregnant women about the Fund, in case theirbaby requires treatment in the NNU. Furthermore, theywant everyone to be made aware that the Fund is forany family, regardless of their financial circumstances.Awareness of the Fund will be promoted to staff throughGlobal emails and more widely though social media. Alink to the Fund will be added to the Maternal and InfantNutrition area of the NHSG webpage. Annual reportingfrom NHS Grampian finance department will be used tomonitor use of the fund. The end year evaluation by theScottish Government is expected to include a surveyof eligible parents and may provide useful informationon barriers to claiming from the Fund which can beaddressed at a Grampian level.Home-Start is a voluntary organisation thatoffers support, friendship and practical helpto local parents in their own homes. Two oftheir client mums described their experienceapplying for Best Start: Mum 1 had found it easyto apply online. She felt it took a long time forthe grant money to arrive, but accepted thatshe had applied on the day it was launched inDecember and likely the number of applicationswas huge. With the money this mum boughta cot (which will convert to a bed), mattressand bedding, hoping it will last a few years. Shewasn’t sure what she would have done withoutthe Best Start Grant money and was very happywith it. Mum 2 also applied online. She’d found itvery easy and received the grant money within2 weeks. The money has been used to pay offdebts as she wants to avoid a bad credit ratingin future.NHS Grampian will provide more support for childrenand families in the very earliest years through theUniversal Health Visiting Service and Family NursePartnership Programme. These require routine enquiryabout family finances/money worries a Pre-Birth (32-34weeks); 11-14 Days; 13-15 months; and 4-5 years (2020).A new digitised recording system for Health Visiting iscurrently being developed and it is anticipated this willinclude the ability to identify the number of HealthVisiting contacts made per and the number of familiessignposted to financial support services.Every family, regardless of their financial status, canclaim support from the Neonatal Expenses Fund. NHSGrampian will continue to promote the NeonatalExpenses Fund (NNEF), with the aim especially toencourage vulnerable parents to apply, so that they maybe supported to spend as much time as possible withtheir babies receiving care within a neonatal unit. In the2018/19 financial year, 152 claims were submitted to theNeonatal Expenses Fund in Grampian, relating to 75babies and families. Of these, 151 were approved with asum total of 15,517.85 paid.National Evaluation of the Family Nurse Partnershipprogramme shows that the programme is well receivedby clients, attrition is low and enrolment is high. Dataregarding clients who have received support from theprogramme at child’s second birthday show two clearoutcomes: a reduced amount of time spent with inputfrom social services and a reduced amount of timespent with housing services as clients move through theprogramme.Every bedside pack at the Aberdeen Maternity HospitalNeonatal Unit (NNU) includes a pre-stamped claimform for the NNEF, so parents can claim on a weeklybasis for travel and a daily main meal cost.When parentsfirst come to the unit, the daily expense of visitingtheir baby isn’t a priority for them, but ward staff raiseawareness of the fund once their baby is settled. Theforms are processed locally and a cheque is sent to thefamily. Should a family require money more immediately,they can receive payment from the General Office atNHS Grampian will promote the importance of HealthyStart with the aim to increase access to the schemefor eligible vulnerable families. NHS Grampian’s HealthImprovement Team lead on the Healthy Start Schemeacross Grampian.The team works closely with midwifery,7
Child Poverty Local Action Report, AberdeenshireEarly Years Practitioners, HSCP, local authority, and thirdsector
Child Poverty Local Action Report, Aberdeenshire June 2019 5 Tier 1, the brief conversation, to ensure we normalise a holistic approach to people’s needs, including all aspects of income maximisation. The actions with the Aberdeenshire Child Poverty Action Plan which NHS Grampian are leading on reflect this Learning has
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