An interview with Director of Public Health (Greater Lincolnshire) Professor Derek Ward
Lincolnshire is one of the largest counties in England. Much of the county is rural with many dispersed populations of a few homes based around agriculture. This brings additional cost of living challenges including transport costs, households not connected to gas supplies so relying on oil heating, and people living at a distance from sources of support.
Planning and coordination
Lincolnshire is an upper-tier council with seven districts. The county, districts and partners from the NHS, the voluntary and community sector, housing providers, and others work closely together on strategic development and local delivery. Successful collaboration during the pandemic is forming the basis of partnership work on the economic crisis. The districts and their local partners have the primary role in delivering support. Public health leads on advice, data and intelligence including district profiles, and identifying overlaps, synergies and gaps. It provides support and coordination for strategic planning and local delivery.
Two long-standing partnerships have an important role in developing cost of living support. The Housing, Health and Care Delivery Group is responsible for interface areas such as the disabled facilities grant and warmer homes. Lincolnshire Financial Inclusion Partnership (FIP) works to improve financial resilience and wellbeing in areas such as financial capacity, responsible credit, debt advice and emergency help, and benefits. The FIP agreed key principles to frame the cost of living work response: clear communication; coordination; act decisively and at speed when needed; influence-up to government on the problems people are facing.
Lincolnshire has established a senior task force of all partners, including the integrated care board, county and district councils, community and voluntary sector and businesses, to review the impacts of cost of living through the autumn and winter and to harness the efforts of all partners to support communities where possible.
Cost of living support
The district councils have set up comprehensive cost of living pages highlighting the full range of support available across Lincolnshire and within their areas. The information is accessible through the districts and the overarching Lincolnshire Connect to Support website. As well as co-ordinating efforts to ensure consistency in support across the county, each district has also taken action of their own (supported through the countywide taskforce by public health advice). Examples include the City of Lincoln Council publishing and issuing a cost of living support leaflet to households in the city and West Lindsey District Council holding a Cost of Living Summit, the findings from which have been taken forward through the taskforce.
Warm spaces in districts across the county are registered on the national warm and welcome portal. Public Health has supported this by co-ordinating core county council related advice, such as safeguarding and domestic abuse guidance, for communities seeking to establish warm spaces.
Lincolnshire has a highly active food partnership which works to promote all aspects of food related health, poverty and sustainability across the county, including information on community food growing and food banks. Districts are involved in this process. For example, City of Lincoln supported the Lincoln Community Grocery to re-locate to a permanent premises in January 2023, supported by the Government’s Be Lincoln, Town Deal and in partnership with the Message Trust. The grocery also offers free courses in cooking, life skills and budgeting.
Impact on future plans
Public health and partners will monitor and respond to the economic crisis through the winter and evaluate the position in the Spring. Unlike the pandemic, which took up most of public health time and resources, the health and wellbeing strategy is still being delivered. The immediate crisis will pass, but there will be a legacy of increased health inequalities which will need renewed efforts. The DPH’s Annual Report for 2022 analysed local data across four types of communities in Greater Lincolnshire and will be used to support the delivery of health, care and wellbeing support, including addressing risks associated with cost of living challenges.
Lincolnshire County Council is coterminous with Lincolnshire integrated care system. Lead Lincolnshire councillors and the DPH attend the integrated care board (ICB) and the Executive Councillor for NHS Liaison chairs the integrated care partnership. The NHS is increasingly engaged in the health inequality agenda, including its role as employer and anchor organisation for relationships with communities, such as potential for local procurement. There is a strong joint approach to population health management and the ICB has agreed a joint team with the council to work on health inequalities.
Another area for future work should be developing a whole-person approach in secondary prevention so that effective healthcare is aligned with action on the wider determinants. For example, making sure that people with asthma can use inhalers properly while also tackling environmental issues such as cold or damp homes.
More can be done to learn and apply the lessons of COVID-19 which also apply to the economic crisis. For example, there needs to be greater focus at a local level on developing resilience in vulnerable groups that are impacted most by such pressures.
National changes that could make a difference
- Longer funding settlements for councils of five years or more to allow greater financial stability and better planning. If this is not possible immediately, there should be plans to work towards this.
- Better, more timely, place-based data and intelligence from the ONS to assist local planning.
- A renewed national focus on those who would benefit from greater support. For example, unpaid carers who, national campaigns show, do not receive equitable treatment in terms of benefit entitlements.
As a county council, much of the delivery of health and wellbeing support, including for the rising cost of living , is through Lincolnshire’s district councils. Public health has a planning and coordination role.
I am a district and town councillor, as well as executive councillor for health and care, and I see the excellent work done in partnership with the districts. I am particularly proud that we have maintained progress on homelessness since the pandemic, with very few people sleeping rough through this winter. Working with the voluntary and community sector, we have an extensive system of foodbanks plus other initiatives, such as low-cost bags of food available.
I am a member of Lincolnshire’s Integrated Care Board and our colleagues in the NHS are supporting the cost of living response. In the longer term, some of the coastal areas of Lincolnshire have received levelling up funding, including the Campus for Future Living at Mablethorpe. This partnership with the NHS, local universities and others will be a centre of excellence for health and care training, technology and good practice. The DPH and I are working closely with this initiative to make sure that it makes the greatest difference to local health and prosperity.
Wendy Bowkett, Executive Councillor for Adult Care and Public Health