Grandparents – the ‘hidden army’ of kinship carers

mamy and the little boy

By Heather Cameron

Tomorrow is the International Day of Older Persons, designated by the United Nations in order to recognise the important contributions made by older people, while raising awareness of the issues of ageing.

Today there are around 600 million people aged 60 years and over world-wide. A number that is set to double by 2025 and reach 2 billion by 2050.

With people living longer and healthier lives, it is not surprising older people are playing a considerably more active and increasingly important role in society. Not least when it comes to contributing to the care of their grandchildren.

Extent of kinship care

Kinship care – when children are brought up by relatives or family friends in the absence of their parents – has grown markedly in recent years.

It is estimated that between 200,000 and 300,000 grandparents and other relatives are raising children who are unable to live with their parents. Common reasons cited for this include abuse and neglect, parental illness or disability, parental substance misuse, domestic violence or death of a parent.

In examining the prevalence of kinship care, drawing on census data, a recent University of Bristol study found that there has been a 7% increase in the kinship child population in England since 2001 – more than three times that of the population growth rate of all children in England, which was 2% over the same time period.

The study also found that one in two (51%) children were growing up in households headed by grandparents.

Positive outcomes

With regard to the children in kinship care, research suggests that they do ‘significantly better than children in care’, both emotionally and academically.

Indeed, a recent study on the educational outcomes of looked after children found that children in long-term foster or kinship care made better progress than children in other care settings.

The largest kinship carer survey in the UK, conducted by Family Rights Group, also highlights the effectiveness of kinship care in preventing children entering or remaining within the care system, to the benefit of both the child and the public purse. The data found that 56% of children had come to live with the kinship carer straight from the parents’ home, with 27% having been in unrelated foster care.

The caring contribution of grandparents has also been shown to have made a material difference to maternal rates of employment.

And as 95% of children being raised in kinship care are not officially ‘looked after’, billions of pounds are saved each year on care costs.

But while benefiting the public purse, and despite evidence that kinship children have better outcomes, many kinship families face a financial burden. The University of Bristol study found that 40% of all children in kinship care in England were living in households located in the 20% of the poorest areas in England (an improvement of only 4% since 2001), and three quarters (76%) of kinship children were living in a deprived household.

Impact on grandparents

As there is no statutory requirement for local authorities to make provision for kinship carers and no automatic right to child benefit, many receive no formal support; leading to financial hardship, and the stress that comes with it.

Many kinship carers have had to give up work or reduce their working hours, either permanently or temporarily. And this is often their main source of income.

A study from Grandparents Plus on discrimination against kinship carers found that of the 77% of grandparents that have asked for professional help, only 33% received the help they needed. And 30% said they didn’t receive any support at all.

The study also found that, overall, kinship carers score ‘significantly below average’ when it comes to their wellbeing.

Other recent research has suggested that regular and occasional care for grandchildren can impact on the mental health of grandparents. The findings indicated that ten additional hours of childcare per month increases the probability of developing depressive symptoms by 3.0 and 3.2 percentage point for grandmothers and 5.4 to 5.9 percentage points for grandfathers.

Policies that substitute informal with formal childcare, it argued, could improve the mental wellbeing of grandparents.

Of course there are positive impacts on grandparents too, many of whom find caring for grandchildren rewarding and who enjoy closer relationships with them, which can in turn have a positive effect on their health. As the research suggests:

the effect of grandchild care provision on grandparents’ health seems to depend on its intensity, the cultural context, as well as on its stability and change.”

Final thoughts

It is clear that grandparents play an increasingly vital role in family life. But it seems this role is in need of greater recognition and support, if society is to continue to benefit from this ‘hidden army’ of kinship carers.


If you enjoyed reading this, you may also be interested in our previous blog on the economic opportunities of an ageing society, published on last year’s International Day of Older Persons.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Housing matters: our recent publications cover issues from homelessness to housing and health

tiny houses 4

By Heather Cameron

The Chartered Institute of Housing (CIH) annual conference and exhibition, the largest housing-focused event in Europe, takes place this week. Over the next three days the conference will examine and explore the political and policy environment, the economic outlook and the latest thinking across the sector.

A variety of topics will be addressed, including housing supply, housing policy, social housing, welfare reform, regeneration and homelessness. These topic areas feature extensively on our database, some of which we have also written about. So this is a good opportunity to highlight some of our recent publications in this area.

What we’ve published

Our most recent ‘In focus’ briefing looks at housing retrofitting, something that has been highlighted as essential for improving the energy efficiency of our housing stock. It considers the benefits of renovating domestic properties to improve energy efficiency and environmental performance and describes the features and technologies of retrofit, such as heat pumps, combined heat and power and various types of insulation. The environmental, economic and social benefits as well as the barriers are summarised. Recent developments concerning retrofit schemes introduced by the UK government and the devolved administrations are also described, and there are examples of good practice from the Netherlands, Sweden and the UK.

Last month we published Delivering solutions to tackle homelessness (Ideas in practice), which looks at the scale of homelessness across the UK and its causes, and provides innovative examples of projects and initiatives that are tackling the problem.

The examples of innovative approaches highlighted include:

We have also written a series of blogs on the topic of homelessness. These include a look at the Christmas Dinner campaign for the homeless run by Scotland’s not-for-profit sandwich shop, Social Bite, while also highlighting the recent increase in homelessness in Scotland and the UK, and the shocking number of homeless children at Christmas.

Another blog post looks at the problem of the hidden homeless and its financial and human costs.

Digital inclusion and the social housing sector is the topic of another ‘In focus’ briefing. This looks at the benefits of digital inclusion, the barriers to digital inclusion for social housing tenants, and how these might be overcome. It refers to a 2012 report which found that almost half of the UK’s adult population who do not use the internet live in social housing, suggesting digital exclusion is a particular problem in the sector. It includes examples of good practice and highlights the importance of digital inclusion in the context of welfare reform.

We also recently blogged on this topic, highlighting one of the examples of best practice featured in our briefing: a case study of a collaboration between Reading Room – a digital consultancy which joined the Idox Group in 2015 – and Catalyst, one of the leading housing associations in London and the South East. This collaboration highlights the potential of technology for improving communications between social housing providers and their tenants, and for encouraging more people to reap the benefits of going online.

Another topic we have looked at is the integration between housing and health. Housing conditions can affect the physical and mental health of people, and can contribute to many preventable diseases and injuries. The ageing population is also putting pressure on the NHS, and growing numbers of older people have to stay in hospital longer because their homes are unsuitable for their recovery. Our briefing notes that housing associations, local authorities and healthcare providers have been working on solutions to tackle these challenges, and provides case studies from London, Tyneside and Bristol as examples of greater collaboration between housing and health services.

The challenges of an ageing population for the housing sector has also been highlighted in our briefing on meeting the housing needs of older people. It indicates that there will be a need for: adaptations to existing housing stock; mainstream rented accommodation built to accommodate wheelchair users; and newly built specialist accommodation. Examples of good practice – including case studies of extra care housing from Calderdale Council, and adapting homes for older and disabled residents in Knowsley, Merseyside – are highlighted.

This is just a flavour of what we’ve recently covered on housing-related topics, and we will inevitably produce more as the sector responds to a time of change and uncertainty.


Some of our briefings are only available to members of the Idox Information Service.

Follow us on Twitter to see what developments in policy and practice are interesting our research team. 

The Town Meeting: the award-winning planning engagement project, one year on

Scene from the "Town Meeting"

Scene from the “Town Meeting”

In this guest blog post, Dr Paul Cowie from the University of Newcastle reflects on an exciting year for the Town Meeting project, which uses theatre to engage communities in planning.

It’s now a year since we started the Town Meeting project and 7 months since the project won the Sir Peter Hall Award for Wider Engagement at the 2015 RTPI Research Excellence awards.

The Town Meeting uses theatre as a way of co-producing research into public participation in planning with communities themselves. The Town Meeting has been performed in 12 communities across the north of England. The use of theatre in this way is unique and has engaged audiences in the issues in a way that traditional forms of research cannot. If you are interested to find out more about the project and the play, we have written a blog about it here and produced a ‘behind the scenes’ podcast about the development process here.

The impacts of the RTPI award

One of the major impacts of winning the award has been to develop the credibility of the project with both professionals and funders. The initial phase of the research was all about understanding the issues in more detail. We’ve now had a chance to do that and the second phase of the project has been to try to change planning practice to address some of the concerns raised by the participants in the project.

To undertake this new phase of the project we have been fortunate to get funding from the ESRC Impact Accelerator Account scheme and Newcastle Institute for Social Renewal. Having the research recognised by a professional body, the RTPI, through the Research Excellence Awards was invaluable in making the case for further funding.

The new phase of the project aims to take the lessons learnt from the play and turn that into a tool which planners can use to co-produce knowledge which can inform strategic planning.

Bringing planning and health together

So far we have worked with health professionals and planners to explore how planning and health can be reunited. In the workshop, health professionals and planners were presented with a proposal to build a super-casino in a run-down seaside town. The play provided a forum for the planners and health professionals to discuss the wider implications of development proposals in a new way.

The event highlighted the lack of understanding that health professionals have of the planning system. It’s often felt that planning can be the solution to many problems but it has been clear from the project how little citizens and professionals alike understand the process of planning and its limitations.

Collaborative planning

We are now about to start working with Northumberland National Park Authority to assist in the development of their new local plan. Through a new version of the play it is hoped communities can understand the importance of the local plan in framing any later planning decision that may affect them.

Previous performances of the play and discussions with audiences have made it clear people only get involved in planning issues at the point when it’s often too late to have any meaningful impact on that decision. The paradox is that at the point at which they can make a meaningful difference, the preparation of the local plan, it is often difficult for communities to see the relevance to them.

Using a play as a tool in collaborative planning can therefore turn the abstract process of preparing a local plan into something meaningful by showing how it has a direct impact on later planning decisions which may affect them greatly. The play also allows the community the freedom to create a vision for their local area, in this case the National Park.

Gaining the trust of planners from the National Park was helped greatly by the award. There is a degree of risk on their part in taking on this untested, and some may say frivolous, method of plan production. The award has given the planners the confidence to take that risk.

We are hopeful that the next year will lead to some concrete outcomes for the project, and to the play making a meaningful difference to the way communities and planners co-produce knowledge about places that matter to them.

Final thoughts

At a recent performance of the play in Cockermouth, the ‘Blennerhasset Village Parliament’ was mentioned. I had not heard of this and asking around the department, neither had any of my colleagues. Started in 1866 as a way involving the whole population in the governance of the community, the village parliament was an example of community governance in the 19th Century.

It was a reminder that sometimes we think we are being innovative when in fact we are merely repeating history – and of the fundamental value of engaging people in the process of research.


Dr Paul Cowie is a Research Assistant in the School of Architecture, Planning and Landscape at the University of Newcastle. Paul’s research focuses on community planning and community representation in the planning process. In 2015, Paul and his project The Town Meeting won the Sir Peter Hall Award for Wider Engagement at the RTPI Awards for Research Excellence.

This year, the Idox Information Service will again be sponsoring the RTPI Sir Peter Hall Award for Wider Engagement, as well as the Student and Planning Consultancy Awards.

The closing date for applications to the awards is 31 May 2016. Further information and application forms are available here.

Evidence use in health and social care – introducing Social Policy and Practice

SPP screenshotWith public sector austerity and the integration of health and social care, it seems as though the need for access to evidence-based policy and practice has never been stronger. Initiatives such as those from the Alliance for Useful Evidence, most recently its practice guide to using research evidence, have highlighted the importance of using trusted sources rather than “haphazard online searches”. One of these resources is Social Policy and Practice, a database which we have contributed to for twelve years.

“SPP is useful for any professional working in the field of social care or social work who can’t get easy access to a university library.” Alliance for Useful Evidence, 2016

The journey to a new resource

A recent article in CILIP Update has explored the background to the Social Policy and Practice database, and its contribution to ensuring the inclusion of grey literature and a UK-perspective within systematic reviews. Update is the leading publication for the library, information and knowledge management community and they’ve given us permission to share this article with our blog readers.

We’ve written before about the value of UK-produced databases within a global publishing context. The CILIP Update article makes the point that when conducting any search for evidence, it’s important to look beyond the major databases to more specialist collections, to source grey literature and to look beyond geographical borders.

This was one of the major drivers in 2003, when the heads of the Centre for Policy on Ageing, the Greater London Authority, Idox Information Service, National Children’s Bureau and Social Care Institute for Excellence agreed to pool their resources and create the first national social science database embracing social care, social policy, social services, and public policy.

The proposal was met with great enthusiasm by the sector which recognised a gap in provision. The new Social Policy and Practice database was launched in November 2004.

The strengths of consortium working

Bringing together these organisations was relatively simple. They were all striving to provide evidence and information to their staff, members or customers. They all also had a professional drive to share their focused collections with the wider world of researchers and to influence policy and practice.

Through developing best practice and troubleshooting problems together, we have improved not only the Social Policy and Practice database for users but also improved our own individual collections. All whilst remaining independent and focused on our individual specialities.

Continuing to evolve

The NSPCC joined the database consortium in 2015, bringing its collection of resources focused on child abuse, child neglect and child protection. The NSPCC library is Europe’s largest collection of publications dedicated to safeguarding children. It includes journal articles, books, academic papers, leaflets, reports, audio-visual material, websites and digital media on all subjects that help researchers, policy makes and practitioners protect children from abuse and neglect.

Social Policy and Practice now boasts over 400,000 references to papers, books and reports and about 30% of the total content is grey literature. Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care.

We’re proud to be contributing to the knowledge base for social research, policy and practice!


To find out more about Social Policy and Practice (SPP) database for evidence and research in health and social care, or to get a free trial, please visit www.spandp.net

Read some of our other blogs on evidence use in public policy:

What is Reablement in healthcare and how is it done?

By Rebecca Jackson

Reablement, or enablement is the process of rehabilitating people to allow them to regain some or all of their independence. Often promoted as a form of intermediary care, reablement programmes are recommended for patients who have had a stay in hospital, in order to reduce dependence on the local social care system or traditional ‘care at home’ programmes.

They often result in longer periods of one-to-one contact than ‘care at home’ programmes  – trained professionals work with patients and their family to encourage and promote the achievement of personal goals. It also provides an intermediary stage between health care and social care, which can help the patient transition. Effective reablement programmes are an example of health and social care bodies working together to deliver holistic, person-centred care.

Cooking Together

What makes an effective reablement programme?

Reablement programmes cover a range of everyday tasks such as how to tackle stairs, how to wash and dress and how to prepare and cook meals. It encourages service users to develop the confidence and skills to carry out these activities themselves in order to continue to live at home.

The programmes are planned and delivered by trained reablement professionals – they involve home care staff working in tandem with physiotherapists, occupational therapists and other health professionals.

Much of the literature around reablement (enablement) practice centres on core issues which are vital to ensure success:

  • focus on early intervention and prevention;
  • a positive, enabling, co-productive approach adopted by all;
  • a workforce with an ethos of working with people, rather than doing something to them;
  • the active participation of the service user and their family in reablement;
  • ongoing training for staff;
  • information and support for families and carers;
  • integration and collaborative working between health, housing and social services;
  • strong leadership in commissioning, and adequate funding of services to deliver sustainable outcomes;
  • evaluation that incorporates both social and financial service outcomes to demonstrate value;
  • good quality assessment by a practitioner with the right skills and abilities to determine an effective programme.

Senior resting in a wheelchair

Reablement in local authorities

Research has shown that these intensive programmes are effective. A 2007 study for the Department of Health’s Care Services Efficiency Delivery Network found that up to 68% of people no longer needed a home care package after a period of reablement, and up to 48% continued not to need home care two years later.

Almost all of England’s councils are planning, implementing or running a reablement service. One driver is that it is seen as a tool for managing the costs of an ageing population. In the UK, reablement programmes usually last for 6 weeks, at which time care is either passed to a social worker, adult social care team, or patients are asked to pay for the continuation of the programme themselves.

Reablement has been criticised as expensive, and time- and resource-intensive. Like any service working with vulnerable people, it can also be difficult to demonstrate value as there are differing success rates for different patients. However, interviews conducted with people who have received reablement packages have suggested the emotional and long term benefits are significant as are potential savings to care budgets in the future. This is especially the case in terms of the cost of readmission to hospital, which studies have found is reduced in cases where people received effective reablement care.

The local authority in Croydon was recognised in 2013 for its work in promoting and expanding reablement practices. They also developed a programme of pre-ablement, which saw training delivered to vulnerable people before they became unable to carry out tasks. By showing them alternative ways to do tasks, they were able to change things before being forced to. This preventative approach worked within the local authority and is something which could be considered more widely as pressure increases on local authority funding and care capacity.

There is a growing consensus that properly funded and effective preventative services, such as reablement, can deliver cost-savings to health and social care services, as well as improving the lives of patients.


Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Read some of our other bogs on health and social care:

Co-production in social care … a need for systems change

meeting

By Rebecca Jackson

One of our most popular member briefings has been our 2014 introduction to co-production in public services. In fact, it was so popular that we made it freely available to download from our website. For those who don’t know, co-production is an approach to improving or developing services by working collaboratively with the people who use those services. It has become increasingly popular within many types of public services in the UK, but especially in health and social care.

The components of co-production

But what does co-production actually mean in practice? Although every case is different, generally it can be broken down into several processes:

  • Co-design – the planning of services
  • Co-decision making – with regards to the distribution of resources and the allocation of services
  • Co-delivery (of services) – including outlining the role of volunteers and the third sector, and including them in the process if necessary
  • Co-evaluation (of services) – assessment of the outcomes and whether they have been successful for all parties involved.

Legislation and implementation

The 2014 Care Act was one of the first pieces of UK legislation to include co-production as a concept in its statutory guidance, stating that:

‘Local authorities should, where possible, actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community. ”Co-production” is when an individual influences the support and services received, or when groups of people get together to influence the way that services are designed, commissioned and delivered.’

Co-production is now a key part of the implementation of health and social care strategy across the UK. It provides service users with an input on which elements of services are of most use, and which could be altered to make them more effective – particularly important at a time when local authorities are under pressure to deliver more efficient and cost-effective services.

Co-production relates to other strategic priorities such as prevention, wellbeing, a focus on outcomes and the personalisation agenda. It allows people who use services to have a direct input into the design of care services and care plans, so as to create more effective programmes of care.

Implementing co-production can be a difficult transition and requires a whole system approach to change. This means that organisations, such as local authorities, must adopt change at every level to encourage meaningful participation and to embed co-production in day-to-day practices.

Managing change

The SCIE co-production guidance uses a jigsaw model for management of change which may be a helpful way to identify the elements of an organisation which must be altered to effectively incorporate co production.

jigsaw 3The guidance provided by the Social Care Institute for Excellence (SCIE) recommends that:

  • organisations must change at every level, from senior management to front-line staff,  if they want to achieve meaningful participation
  • participation should become part of daily practice – and not be a one-off activity
  • participation operates at different levels, as there are many ways to involve people who use services in different types of decisions

Social care co-production in practice

  • The project PRESENT is a joint initiative between East Dunbartonshire Council, the local Dementia Network, the Joint Improvement Team and Governance International, which uses co-production to engage people with dementia and enable dementia sufferers to make a positive contribution to their communities.
  • Islington Council has developed a Framework for Involvement in Adult Social Care to provide a solid base for co-production that is accessible, inclusive and has impact. The council worked with people who use services and carers to produce the Framework. Local statutory and voluntary sector organisations, including the Making it Real Experts by Experience and Project Team, and Healthwatch Islington, were also involved.
  • A report produced in 2013 by the Scottish Co-production Network, Governance International, the Scottish Joint Improvement Team and the Social Care Alliance,  also provided comparisons between the approaches to co-production in social care between Scotland and Sweden.

These are just a few examples of innovative practice, more of which can be found on the SCIE website.

The potential of co-production

Co-production has the potential to transform the way social care is delivered in the UK. However, implementing co-production approaches into existing organisations, with their own culture, structures and operating procedures, as well as their own expectations about services and how they should be created and delivered, remains a challenge for commissioners, the third and private sectors, politicians and the public.

In order to be successful and to produce sustainable and effective relationships, total change will be required and it will take a huge commitment and long term vision to ensure its success. Once implemented, though, it is clear that co-production has the potential to contribute greatly to prevention, personalisation and outcomes-focused service delivery – which are all key agendas in the current health and social care policy climate.


Read some of our other recent blogs:

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Health Champions – “unlocking the power of communities”

Health Cubes_iStock_000022075266Large

By Heather Cameron

“On the societal level, we must understand that health is not an individual outcome, but arises from social cohesion, community ties, and mutual support.” Dr Gabor Maté

Health inequalities have long been an issue in the UK and despite continuous government commitment to tackling them, they continue to persist.

It is estimated that avoidable illness costs around £60 billion and that 1 in 4 deaths are preventable with the adoption of healthier lifestyles. Calls have therefore been made for radical changes in the approach to public health by improving health and wellbeing outside of the core public health workforce.

This is just the approach of the Community Health Champion model, developed by Altogether Better, which has demonstrated not only the positive impact on health but the social value of such an approach.

What are health champions?

Health Champions are volunteers from all walks of life who are provided with accredited training and support so they can undertake health promotion activities within their communities to reduce health inequalities and improve the health of the local population.

The Community Health Champion role began as a five year Big Lottery Funded programme (Wellbeing 1) in 2008. Over 18,000 Health Champions were recruited, trained and supported between 2008 and 2012, reaching over 105,000 people.

Through a combination of their training and own personal experiences, these volunteers empower and encourage people within their families, communities and workplaces to take up healthy activities, create groups to meet local needs and can signpost people to relevant support and services.

Challenges

While Wellbeing 1 succeeded in reaching many people in need, the programme also raised two specific challenges: in almost all cases, the work being done was invisible to the NHS; and securing ongoing funding to continue the support was difficult.

Peer support was later identified as the most appropriate way of trying to connect communities with health services.

Following this recognition and the success of the original model, further lottery funding was awarded to develop the Champion model and use it to engage champions, communities and health services (Wellbeing 2).

Co-production of health and wellbeing outcomes

The model was applied to health services specifically with the aim of addressing the apparent disconnect between the NHS and community-based services. It helps connect both patients with support in their communities and professional practices with those communities.

Many citizens have volunteered in different ways and in different settings. These include:

  • Practice Health Champions working closely with their General Practice to create new ways for patients to access non-clinical support
  • Youth Health Champions where children and young people are recruited, trained and supported to help young people more actively engage with and influence their own and their community’s health
  • Pregnancy and early years Health Champions who are interested in giving children a better start
  • Health Champions working within a specialist, hospital-based NHS service
  • Senior Health Champions who engage with older people, offering a complimentary approach to more formal programmes

Community-based health improvement initiatives such as this could help to strengthen community-professional partnerships and cross-collaboration among health, social and other services. And this in turn could lead to a reduction in health inequalities.

Positive outcomes

According to a recent evaluation of the Health Champions programme, Wellbeing 2 has resulted in a range of benefits:

  • 86% of champions and 94% of participants in the programme reported increased levels of confidence and well-being;
  • 87% of champions and 94% of participants in the programme acquired significant new knowledge related to health and well-being;
  • 98% of champions and 99% of participants in the programme reported increased involvement in social activities and social groups;
  • 95% of practice staff involved with the programme would recommend it and wish to continue.

Other benefits included reduced social isolation, increased levels of exercise/healthy eating and feeling physically better. One champion reported “this has helped me more than any medication might.”

Success stories  include the work of a cycle champion who has improved her own health and wellbeing, encouraged over 70 other people to improve theirs through taking up cycling, provided cycle training to over 50 people in 6 community groups and provided specific detailed help to 5 people.

Other successes have involved volunteers setting up football training, providing support to women with mental health issues, providing advice and support to ethnic minorities and providing advice on healthy eating.

In terms of monetary value, an  analysis of the social return on investment (SROI) of a series of Altogether Better project beneficiaries found a positive SROI of between £0.79 and £112.42 for every pound invested, highlighting the potential value of these initiatives to funders.

Final thoughts

At a time of increasing demands on health services and with the relentless squeeze on public sector resources, perhaps the move towards greater community empowerment and collaboration across sectors is the right one. After all, as I’m sure we’d all agree, prevention is better than cure.


If you liked this blog post, you might also want to read Heather’s earlier post on social prescribing

Follow us on Twitter to see what developments in policy and practice are interesting our research team.

 

 

Should the UK introduce a tax on sugar?

An assortment of liquorice allsorts sweets.

by Stacey Dingwall

Recent months have seen two enquiries to our Ask a Researcher service for evidence on sugar consumption in the UK. Namely: should this be taxed?

Sugar has become somewhat of a villain in the UK, with magazine articles, research and governments all telling us that we should be greatly reducing, or even eradicating completely, our consumption of added sugars in particular. The week beginning 30th of November even saw the first National Sugar Awareness Week, part of a campaign to encourage the government to establish a sugar reduction programme in the UK. However, is a ‘sugar tax’ really necessary?

Sugar consumption: a public health issue?

According to the Royal Society for Public Health (RSPH), absolutely. Last month, they published a review of how to tackle obesity in the UK, which included the introduction of a sugar tax. The report notes that, according to the latest forecasts, half of all adults in the UK are expected to be classed as obese by 2050. Key to reversing this trend, it is argued, is to tackle issues around diet and nutrition among children, who are now spending double the amount of time per day in front of screens than children in 1995 (something that has been shown to increase cravings for food and drink, but not for nutritionally sound items). Alongside other developed nations, the UK is also seeing an ever increasing rate of consumption of high-sugar carbonated drinks.

While the RSPH recommends placing restrictions, or ending, the use of advertising and sponsorship by junk food and drinks companies around family and sporting events, it also argues that this is not enough to tackle the country’s obesity problem. The RSPH supports the introduction of a tax on sugary drinks of 20%, or 20p per litre. Their report highlights evidence which suggests that this could prevent or delay around 200,000 cases of obesity per year, and points to the experience of Mexico, who introduced a tax of 10% at the start of 2014. During that year, sales of sugary drinks declined by 6% overall, and by 9% among those living in the most deprived areas of the country (the demographic group most likely to be obese).

What does the government think?

After a delay, the UK government published Public Health England’s (PHE) review of the evidence for action with regards to sugar reduction in October. The report:

  • agrees that too much sugar is consumed in the UK
  • favours a reduction in advertising to children
  • recommends the introduction of a tax on full sugar soft drinks of 10-20%

This, combined with a range of other measures, it is argued, could save the NHS £500 million per year. The PHE recommendation was also supported by the House of Commons Health Committee, in their recently published Childhood obesity – brave and bold action report. Having heard evidence from parties including Sustain and Jamie Oliver, a key figure in the campaign for the introduction of a sugar tax, the Committee recommended that such a levy should be introduced at 20%, in order to achieve maximum impact.

The Prime Minister, however, is still not convinced, stating that he believes there are “more effective” ways of tackling obesity. The government is due to publish a strategy on childhood obesity in the New Year.

What does the evidence say?

A number of countries have implemented a form of taxation on sugar or saturated fats. These include:

  • a tax on saturated fats in Denmark
  • Finland’s tax on sweets, ice cream and soft drinks
  • Hungary’s public health product tax
  • France’s tax on sugar- and artificially-sweetened beverages

According to a review of using price policies such as these to promote healthier diets by the World Health Organization, food pricing policies are feasible, and can influence consumption and purchasing patterns as intended, with a significant impact on important dietary and health-related behaviour. Crucially, however, the same review notes a lack of formal evaluation in this area.

A report published earlier this year by the activist group Taxpayers’ Union of New Zealand, Fizzed out: why a sugar tax won’t curb obesity,  questioned the validity of nutrition related taxes. Reviewing the experience of Mexico, they suggested that the reduction in consumption of sugary drinks following the introduction of an excise tax of one peso per litre in January 2014 had been overplayed.

It’s also the case that the Danish tax on saturated fats was repealed by the government after only one year. This was due to a number of economic impacts that quickly became apparent after the tax was implemented, and resulted in plans for similar taxes to be abandoned. In fact, fat consumption in Denmark has been on a downward trend for some time now, therefore no tax incentive was required. And according to the Danish minister of finance, “to tax food for public health reasons [is] misguided at best and may be counter‐productive at worst”.

Whether the UK Prime Minister will be swayed on this matter remains to be seen. It’s likely that a ‘sugar tax’ will continue to be deemed too politically sensitive to introduce, especially as one in five people continue to live below the poverty line.


Related reading
Child obesity: public health or child protection issue?

Our popular Ask-a-Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

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Increasing participation in sport and physical activity

by Stacey Dingwall

Our latest member briefing focuses on increasing participation in sport and physical activity in the UK, looking at successful examples of increasing activity and ways in which policymakers are trying to overcome the barriers to participation in sport and physical exercise. You can download the briefing for free from the Knowledge Exchange publications page.

Physical activity levels in the UK

Despite the longstanding and valued position in British society of sport, getting people of all ages involved in sport and physical activity has become increasingly challenging. While current UK guidelines for aerobic activity recommend that adults aged 19 and over should spend at least 150 minutes per week in moderately intensive physical activity, the latest statistics on physical activity from the British Heart Foundation indicate that:

  • Only 67% of men in England and Scotland report meeting recommended levels of physical activity, and only 59% in Northern Ireland and 37% in Wales;
  • Women are less active than men in all UK countries, with 58% reporting meeting recommended levels in Scotland, 55% in England, and 49% in Northern Ireland and 23% in Wales;
  • Physical activity levels vary by household income; in England in 2012, 76% of men in the highest income quintile reached recommended levels, compared to 55% of men in the lowest income quintile.

The implications of inactivity

Low levels of physical activity not only have health implications, but also economic – in the UK, inactivity has been estimated to cost the NHS £1.1billion (Allender, 2007) with indirect costs to society bringing this cost to a total of £8.2billion.

Government action

Our briefing highlights the range of policies and interventions implemented by the UK and devolved governments to try and increase participation in sport and physical activity among the population. These include the Department of Education’s £150m per year Primary PE and Sport Premium Fund; and Scotland’s sport strategy for children and young people, Giving Children and Young People a Sporting Chance.

Good practice – home and abroad

In addition, the briefing profiles successful interventions at the community level, such as Let’s Get Fizzical, a physical activity programme for young people delivered by StreetGames in collaboration with Birmingham City Council. International examples of good practice are also highlighted, including the Active Healthy Kids Canada programme and the North Karelia Project in Finland.


 

The Knowledge Exchange specialises in public and social policy. To get a flavour of the commentary it offers, please explore our publications page on the Knowledge Exchange website.

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Social prescribing – just what the doctor ordered?

blue toned, focus point on metal part of stethoscope

By Heather Cameron

It is widely acknowledged that wider social, economic and environmental factors have a significant influence on health and wellbeing. According to recent research only 20% of health outcomes are attributable to clinical care and the quality of care while socioeconomic factors account for 40%.

With increasing pressures on GPs and lengthy waiting times a real issue for many, particularly those with mental health conditions, social prescribing could represent a real way forward.

The government clearly recognised the importance of social prescribing in its new deal for GPs announced earlier this year, which made a commitment to make social prescribing a normal part of the job.

In response to a recent Ask-a-Researcher request for information on different approaches in social prescribing and evidence of what works in the UK, it was interesting to find that despite the recognition of potential value, there has been little evaluation of social prescribing schemes to date.

Much of the material found focused on specific interventions and small-scale pilots and discussion around implementation. A new review of community referral schemes published by University College London (UCL) is therefore a welcome addition to the evidence base as it provides definitions, models and notable examples of social prescribing schemes and assesses the means by which and the extent to which these schemes have been evaluated.

So what is social prescribing?

Social prescribing means linking patients with non-medical treatment, whether it is social or physical, within their community.

A number of schemes already exist and have included a variety of prescribed activities such as arts and creative activities, physical activity, learning and volunteering opportunities, self-care and support with finance, benefits, housing and employment.

Often these schemes are delivered by voluntary, community and faith sector organisations with detailed knowledge of local communities and how best to meet the needs of certain groups.

Social and economic benefits

Despite a lack of robust evidence, our investigation uncovered a number of documents looking at the social prescribing model and the outcomes it can lead to. Positive outcomes repeatedly highlighted include:

  • improved health and wellbeing;
  • reduced demand on hospital resources;
  • cost savings; and
  • reduced social isolation.

According to the UCL report, the benefits have been particularly pronounced for marginalised groups such as mental health service-users and older adults at risk of social isolation.

A recent evaluation of the social and economic impact of the Rotherham Social Prescribing Pilot found that after 3-4 months, 83% of patients had experienced positive change in at least one outcome area. These outcomes included improved mental and physical health, feeling less lonely and socially isolated, becoming more independent, and accessing a wider range of welfare benefit entitlements.

The evaluation also reported that there were reductions in patients’ use of hospital services, including reductions of up to a fifth in the number of outpatient stays, accident and emergency attendances and outpatient appointments. The return on investment for the NHS was 50 pence for each pound invested.

Similarly, the Institute for Public Policy Research (IPPR) has recently argued that empowering patients improves their health outcomes and could save money by supporting them to manage their condition themselves.

IPPR suggests that if empowering care models such as social prescribing were adopted much more widely throughout the NHS we would have a system that focused on the social determinants of health not just the symptoms, providing people with personalised and integrated care, that focused on capabilities not just needs, and that strengthened people’s relationships with one another.

Partnership working

With a continued policy focus on integrated services and increased personalisation, social prescribing would seem to make sense. In addition to providing a means to alternative support, it could also be instrumental in strengthening community-professional partnerships and cross-collaboration among health, social and other services.

The New Local Government Network (NLGN) recently examined good practice in collaboration between local authorities, housing associations and the health sector, with Doncaster Social Prescribing highlighted as an example of successful partnership working. Of the 200 referrals made through this project, only 3 were known to local authority and health and wellbeing officers, showing that the work of social prescribing identified individuals who had otherwise slipped through the net.

And with the prospect of an ageing population and the health challenges this brings, a growing number of people could benefit from community-based support.

As Chair of Arts Council England, Sir Peter Bazalgette, notes “social prescribing is an idea whose time has come”.

Follow us on Twitter to see what developments in policy and practice are interesting our research team.

Further reading: if you liked this blog post, you might also want to read Heather’s earlier post on the health and wellbeing benefits of investing in public art.