Responding to cost of living challenges: Leicester

Leicester was the first area of England to enter a ‘local lockdown’ during the pandemic and experienced the longest period under lockdown, so people, businesses and services have taken a longer time to recover. There is less resilience across all sectors, with reserves and contingencies used-up, and less disposable income available. More people require support, including those who were previously ‘just about managing’ but are now struggling with payments including rent and mortgages.

This is an economic crisis with a severe impact on health and health inequalities and, as in the COVID-19 response, the DPH leads on mobilising action across the council and other partners. The approach is to use public health incident management principles, using data and intelligence to identify the most vulnerable. With public sector resources already under severe pressure, it is vital to make every penny “stretch to the maximum”, avoid duplication, and address gaps. A multiagency incident management team has been established to coordinate action, with sub-cells considering topics such as housing, business, and education.

Information about cost of living support is available on the council website. This includes BetterOff Leicester, an online tool to find out about benefits entitlement, job and volunteering opportunities, and to apply online. Partners are working to develop consistency in information such as similar landing pages and links on council, university and provider trust websites.

Cost of living interventions build on the making every contact counts (MECC) initiatives already established in Leicester, and with partners in the Leicester, Leicestershire and Rutland ICS. This includes an initiative with NHS funding to develop an energy advice service in partnership with a national energy advice charity. This involved training in brief conversations for large numbers of staff in venues including libraries and neighbourhood centres.

Leicester’s 16 libraries are designated warm, welcome spaces providing a range of services and support in neighbourhoods. This includes practical advice, workshops on financial and IT skills, job seeking with DWP coaches, benefits checks, healthy living groups such as food and exercise, activities for toddlers, and study space for school children.

Warm spaces are also being provided in venues such as adult education services and across Leicester’s active and diverse voluntary, community and faith sectors. (See national warm welcome portal.) The experience of the pandemic encouraged people to look out for each other, and communities are asking how they can help in the current crisis, but third sector and faith organisations are often struggling with their own energy costs. The council is providing grants to community groups to help them support local people.

Around 36 food banks are operating across the city, some combined with warm spaces. A partnership with local food supplier provided a pop-up pantry for children in receipt of free school meals during half term.

Leicester public health has focused on wider determinants and health inequalities but the increase in poorer health and health inequalities from COVID-19 and the current situation means that it will have to “pedal much harder” to make progress. This is compounded by insufficient funding in public health and across the public sector. The role of public health in influence, persuasion and advocacy is increasingly important.

Cost of living, and its impact on NHS staff and patients, has been a catalyst for greater involvement of the NHS in tackling health inequalities. Local and system NHS partners are committed to this, but there is a danger that national targets mean that local managers cannot put the focus on prevention that they would wish to.

Learning from COVID-19meant that Leicester restructured its ways of community engagement, developing and supporting health and wellbeing champions and networks, which are now helping with the cost of living response. Maintaining ongoing relationships and trust with communities is essential but becomes more difficult when public sector funding to keep up contact is limited.

The business sector in Leicester is a key partner for promoting employment opportunities and prosperity. Public health will continue looking for opportunities through joint work.

• A shift in national policy that makes an explicit link between health and the economy and prioritises health as a key element of prosperity.
• Stronger recognition that areas with people living in poverty need additional resources to break the cycle of inequality. Everyone is experiencing the rising cost of living , but people are not ‘all in it together’. Many are starting from fewer resources and have less capacity to cope.
• Leicester has secured short-term national funding to expand preventative services in mental health and with young people, but time-limited funding that leaves a gap when it comes to an end is not the answer.

Leicester public health has focused on wider determinants and health inequalities but the increase in poorer health and health inequalities from COVID-19 and the current situation means that it will have to “pedal much harder” to make progress. This is compounded by insufficient funding in public health and across the public sector. The role of public health in influence, persuasion and advocacy is increasingly important.

Cost of living, and its impact on NHS staff and patients, has been a catalyst for greater involvement of the NHS in tackling health inequalities. Local and system NHS partners are committed to this, but there is a danger that national targets mean that local managers cannot put the focus on prevention that they would wish to.

Learning from COVID-19meant that Leicester restructured its ways of community engagement, developing and supporting health and wellbeing champions and networks, which are now helping with the cost of living response. Maintaining ongoing relationships and trust with communities is essential but becomes more difficult when public sector funding to keep up contact is limited.

The business sector in Leicester is a key partner for promoting employment opportunities and prosperity. Public health will continue looking for opportunities through joint work.

• A shift in national policy that makes an explicit link between health and the economy and prioritises health as a key element of prosperity.
• Stronger recognition that areas with people living in poverty need additional resources to break the cycle of inequality. Everyone is experiencing the rising cost of living , but people are not ‘all in it together’. Many are starting from fewer resources and have less capacity to cope.
• Leicester has secured short-term national funding to expand preventative services in mental health and with young people, but time-limited funding that leaves a gap when it comes to an end is not the answer.

As the scale of the cost of living pressures  emerged it was clear that, like the pandemic, it needed to be managed systematically as an incident. In this way resources from across the council and its partners could be mobilised to avoid duplication, fill gaps, make best use of limited funding and consider the needs of different populations. Leicester’s DPH is well respected from fronting and coordinating the pandemic response, and the public health remit spans the areas of work that impact on cost of living, so he was the obvious choice to drive and coordinate support.

During the pandemic public health become fully embedded in the council and it became clear how much more could be accomplished by all workstreams taking a holistic approach to addressing needs like safety, health inequalities and the impact of poverty.

Leicester already had a well-developed approach to ‘making every contact count’ with many staff trained to look beyond their remit to provide brief information and referrals on issues such as health, poverty and safety, and we intend to build on this. We are also making best use of community resources – for example, libraries can provide many types of support, from advice and information to social inclusion, as is shown in our warm welcome spaces approach.

With more budget pressures in the coming years, we intend to further develop, and measure integrated working across the council and with partners in the ICS and the voluntary and community sector so that we can continue to deliver in the most efficient way possible.

Alison Greenhill, Chief Operating Officer, Leicester City Counci