*Health and Mental Health Working Group – Creating the new role of Patient Representatives
Project Overview: To scope, train, fund and pilot a new role known as Patient Representatives. These will provide pastoral and navigational help to patients with complex mental and physical needs as they deal with the requirements, departments and provisions of the NHS, DWP and other agencies to achieve optimum access to health and wellbeing provision.
Project Need: The project is being developed in response to the adverse experiences of both MBPTC Community and Civic Commissioners. Those with lived experience of poverty frequently have complex mental and physical health needs as well as needing benefits. The failure to recognise or take into account the various different strands of physical need in a patient presenting at a local surgery or subsequently a hospital consultant often leads to physical and/or mental distress to the patient. This tends to increase the health needs of the patient and the cost to the health service and the DWP. The project addresses the problem in two main ways. Firstly, by meeting with and being represented by a Patient Representative the patient with complex needs can be carefully listened to and guided to the appropriate sources of help thus alleviating unnecessary pain and stress. Secondly, by making sure that the patient’s various strands of need are understood by each service provider, the patient can be assessed and treated to the benefit of the patient’s wellbeing and the NHS/ DWP or relevant Charity’s smooth running.
Project Impact: The project will improve the overall wellbeing of patients with complex physical, mental and benefit needs as well as the smooth functioning of NHS, DWP and Charity professionals and their support teams. The physical, mental and financial health of those with complex needs will improve in ways that can and will be measured both by the service providers and the patients in liaison with their Patient Representatives. It is expected that the Pilot project will indicate a significant improvement in the mental health of patients with complex needs and a significant reduction in the length of consultations and frequency of visits made by such patients to the service providers.
Case Studies: Patients whose mental health needs are not met at appointments for physical health and vice versa. Patients whose social/financial/housing needs are negatively impacting their health and successful treatment. Patients whose complex needs prevent them from benefitting from clinical appointments and/or prevent them from receiving relevant achievable treatment and advice.
Other Potential Initiatives to be defined and delivered during 2020/2021: Establishing Patient Truth Commissions. Staff Training to implement a “Kindness Culture.” Creation of “Personal Information Cards” (like a bank card) to hold key data relating to patient records across organisations.
*Community Working Group
Project Overview: i) To work with United Utilities to share experiences of how to support people struggling to pay their bills. Furthermore, looking at how all utility companies can support people who are just leaving recovery and may never have paid a bill in their life. The longer-term view is to roll out a workable model to other utility companies to provide comprehensive support to people struggling with poverty. ii) To work with United Utilities to improve their provision to the Traveller Community Mellishaw site.
Project Need: Currently people struggling with poverty had to go into debt before any support is given from United Utilities. Community Commissioners worked with United Utilities to change this system to support people before they go into debt and hence avoid the spiralling pitfalls of ever-increasing debt. Community Commissioners also want to raise the issue of rateable value of a property and how someone living in a small 2-bed flat on a council estate can have significantly higher water rates than someone living in a 4-bed house in a wealthy area. The layout and design of the bills needs looking at so as not to instantly discourage people struggling with poverty. People leaving recovery are at a particularly vulnerable stage in the recovery process and a greater understanding and awareness of the time and support they may need in learning how to pay bills is essential to their recovery, and ability to participate fully in life. Lack of support at this stage only leads to a slip back to addiction at a substantial cost to many different services. Other utility companies are notorious for overcharging, cutting supply, and leaving people who live in poverty in serious debt and a vicious circle of decisions over whether to have the heating on, buy food or pay the rent, resulting in bailiffs, loan sharks, and poor health both mental and physical. The Traveller Community on the Mellishaw site were under threat of eviction which stress had been added to with the difficulties with utilities provision.
Project Impact: i) People living in poverty will benefit from having support before they are in debt by avoiding loan sharks, thus incurring more debt in a never-ending circle. Changing the layout of bills and including support information will encourage people to engage with the issue rather than instantly assuming they are in debt and ignoring the bill, assuming there is no support. People leaving rehabilitation will be supported on their recovery journey, being allowed time to learn how to reintegrate into life, including paying bills. It can be completely overwhelming and counterproductive to any progress made to have to try and reintegrate too fast. ii) The Traveller Community will know that they have serious friends standing alongside them to defend them from prejudice and disadvantage.
Case Studies: Community Commissioner – “I had never had to pay a bill in my life, I had spent 15 years in and out of heroin addiction, never being given the time needed to fully recover. When I finally did get that time, and was supported in learning how to pay bills and find a job at my own pace. I was then able to re-enter life and am now employed and contributing to society again rather than draining money out of the NHS by a vicious cycle of rehabilitation and relapse due to lack of understanding and awareness of the time needed to properly reintegrate. It takes time to learn how to do the so-called simple stuff like paying bills, or making appointments that most people just take for granted.”
Other Potential Initiatives to be defined and delivered during 2020/2021 School assembly and education resource to raise awareness of living with poverty whilst at school. Work with the Eden Project to deliver benefits within the local community. Work with Lancaster City Council and other partners to produce an area wide food poverty action plan aiming to link vital services and support groups together more efficiently.
*Welfare and Benefits Working Group – DWP Job Coaches
Project Overview: Community Commissioners with lived experience of poverty to share their experiences of being on Universal Credit with Job Coaches and DWP Leadership Teams to inform staff training and process changes.
Project Need: Project will raise awareness of the struggles people face when applying for or living on Universal Credit. People who are struggling with poverty also want to understand the stresses that Job Coaches face on a daily basis. People with different experiences of applying for Universal Credit will speak including those in recovery, 2 people in work on variable wages and a light touch UC programme, one person who had to apply from psychiatric hospital, and another who had to apply when seriously mentally unwell. Project will work with DWP staff to help them recognise the complex needs form that CAB produce as reliable evidence that someone has complex needs and may well struggle on UC at least initially.
Project Impact: Project aims to change perceptions and increase understanding of the pressures people on both sides of the Universal Credit desk face. Success to be measured by the meetings even taking place as this has never been done before as far as we know and people on both sides are extremely nervous about taking part in such an exercise. Success longer term is harder to measure, based upon Job Coaches becoming more able to be more understanding and compassionate in the difficulties people face on Universal Credit. People on Universal Credit will feel heard, and more cared about even if their financial situation does not change. If complex needs form is accepted as evidence, people will be under less stress to “prove” they have complex needs and therefore be at less risk of sanctions.
Case Studies: Community Commissioner – “Applying for Universal Credit at a time when I was seriously mentally unwell was a living nightmare, I would like to try and share my experience so that other people will be treated with more compassion and understanding than I was. Nobody should have to go through the humiliation I did.”
Other Initiatives defined and delivered during 2019-20: Rewording of Lancaster City Council letters into simple English. Changes to Lancaster City Council procedures relating to council tax debt recovery. Ongoing support to the Traveller Community now that the working group successfully helped them to avoid eviction by influencing the purchase of the Mellishaw site for the Traveller Community by Lancaster City Council.