An interview with Rachel Wigglesworth, Director of Public Health, Cornwall and Isles of Scilly
Cornwall has high levels of deprivation and has a low wage, seasonal economy. Wages are around 80 per cent of the national average, leading to families and children living in poverty. The rurality of the county means that people have large transport costs, and almost half of the population are not on the mains gas network, compared to 14 per cent nationally. The county also experiences high numbers of excess deaths in the winter months.
Planning and coordination
Public health leads on delivering insight work and coordinating action on tackling health inequalities across Cornwall and the Isles of Scilly, including the impact of the rising cost of living on vulnerable individuals and groups. The Cornwall and Isles of Scilly Leadership Board met in Spring 2022 to consider the potential impact. This was followed by a series of local community events over the summer which fed back at September’s ‘Turning the Tide’ summit, attended by strategic and community leaders from all sectors and convened by the Director of Public Health.
The outcome of the summit was a statement from the leader of the council addressing the cost of living challenges of residents and community leaders. The statement has seven commitments including food, fuel and increasing long-term prosperity. An overarching group was set up to drive and oversee delivery, and the DPH, as senior lead on cost of living for the council, coordinates the group. Cornwall’s cost of living response builds on the strong community alliances that were established during the pandemic.
Cost of living support
Key initiatives include the following:
- A review of debt collection practices across partners to prevent and reduce debt, and help people stay in their homes, and improve mental health.
- A joined up approach to information including roadshows, online advice and information, leaflets, and targeted campaigns to maximise income, for example by applying for pension credit.
- Winter support through community hubs – a partnership of over 50 voluntary sector organisations, working with the NHS and the council, are providing warm spaces, activities, access to practical information on money management, energy saving and benefits entitlement, social and practical activities including cooking skills and IT and signposting to further help. A new community gateway service has been established for support in people’s homes if they are not able to access community hubs.
- Information, advice and grants on energy and fuel poverty – the public health team coordinates grant applications for home energy improvement.
- Information on projects to help alleviate food poverty is available through the independent Food Access Alliance which public health helps to coordinate.
- Public health’s Healthy Cornwall Team is being asked to provide cooking on a budget sessions in communities.
- A range of longer-term measures enabled by the County Deal and Shared Prosperity Fund to improve the quality of work opportunities, and exploration of options to trial a basic income pilot across Cornwall.
Impact on future plans
The rising cost of living feels like a ‘tsunami’ of need at a time when public sector budgets are shrinking. It will leave a legacy of health inequalities and it is unclear when things will improve. Other challenges also need addressing. In early 2022 Storm Eunice left thirty thousand houses in Cornwall without fuel for up to ten days. The county is working to increase resilience to the impact of climate change.
There are also opportunities. The council and the ICS are coterminous, and the NHS is increasingly focused on health inequalities. Building on the success of social prescribing approaches, the ICB is recognising the value of the voluntary sector and providing funding for community resilience. Public health is leading on developing the shared population health management approach, including joint data and intelligence for primary care networks. This helps to target prevention programmes and to shape support for people with the poorest health
Cornwall has focused on creating opportunities for wellbeing and prosperity, and public health has been involved in many initiatives to address the wider determinants. These include a mental health employment programme with mental health advisors in job centres funded by the DWP, and debt management for people with mental health problems.
Community resilience is central to the work of public health. The topic of the DPH’s latest annual report is a community asset based approach to health.
A Cornwall devolution deal has recently been announced which will provide further opportunities to work on the social determinants of health. The deal commits to Cornwall being an early adopter for public health innovations, with a vision for Cornwall to be a leading global healthy place to live.
National changes that could make a difference
- A national strategic and policy framework which recognises and tackles the main drivers of health and other inequalities.
- Commitment to an evidence-based food and obesity strategy and transition to a more sustainable food sector.
- Supporting ICSs to be strong partners of councils in prevention and improving wellbeing as well as NHS priorities.
Chief executive perspective
Learning from the pandemic has had a major influence Cornwall’s cost of living response. Two areas, in particular, reflect the role of public health.
- COVID-19 showed the value of an asset-based approach to community wellbeing and resilience. Public health did an evaluation of community involvement in the pandemic and now leads on developing asset-based approaches. The role of communities is central to helping support people through the current crisis.
- Data-sharing arrangements advanced in the pandemic and are now underpinning the cost of living response. Cornwall’s Insights Dashboard contains key indicators populated by timely data which is used to influence strategic and operational decisions. For example, the dashboard collects data from Citizens Advice which shows that the most requested information is on household energy. Data from the Trussell Trust on food banks shows significant increases in usage from people in work, such as teaching assistants and home carers. This type of intelligence is used to influence the use of the Household Support Fund.
The pandemic and cost of living crises are viewed as ‘rising tide’ events linked to longer term interventions such as the county’s Net Zero Action Plan to tackle the environmental emergency in which the DPH is closely involved. The crisis will have an impact on health and prosperity longer term, and the DPH works closely with the People and Prosperity Team on increasing economic wellbeing, including preparation for the best use of the Shared Prosperity Fund.
Since joining local government, public health has developed and matured. I am very pleased with how public health works across the council and is embedded in Cornwall’s ICS.
Kate Kennally, Chief Executive, Cornwall Council