Christmas, a Birth, and a Problematic Foodbank Report

Hayley, whose baby is due next week, came to this Greenwich foodbank for help.
Hayley, whose baby is due next week, came to this Greenwich foodbank for help.

I apologise in advance for the length of this post. There’s a lot to say. Hayley is a 31-year-old mother of two and is heavily pregnant. She came to the food bank at the weekend with her partner and her youngest child of nine. Her baby is due next week, but her family is not in a celebratory mood. This young family’s cupboards are empty. It’s the first time in their lives they’ve ever had to ask for a food bank voucher.

They’ve hit a full-blown crisis. Hayley is a domiciliary care worker. Because she normally gives birth prematurely at 27 weeks, she went onto statutory sick pay three months ago. She was naturally wary given her earlier pregnancies, and by that stage she also couldn’t do the hoisting and lifting that her job requires. Moving onto sick pay reduced her income from £1,000 a month to £300. She then went onto maternity benefit in November, and has recently applied through the council for housing benefit. This application has been turned down. She recently applied to Her Majesty’s Revenue and Customs (HMRC) for child tax credit, and a payment of £30 a week was awarded two weeks ago.

Her anxious-looking partner took their child off for a while so that I could talk to Hayley. Her partner works as as driving instructor. He’s self-employed, and business has been very slow lately. He has no clients booked in over the Christmas holidays, but he’s still expected to make payments to the franchise he belongs to. The most daunting problem they face as they wait for the new baby to arrive is their housing situation.’We’ve got to pay £140 a week rent to London and Quadrant Housing Association. My partner is self-employed, but he has no clients and no work over the Christmas period. But we still have to pay his franchise fees for the business. The tax credit people have told me to ring them when I’ve had the baby. After the baby’s born they’ve said they’ll get me to fill in another form. London and Quadrant have given me the food bank voucher, but they still ring me every week for the rent.’ How do those calls make her feel? ‘It makes me feel embarrassed and upset.’

She contacted her children’s schools – her eldest is 13 and at secondary school – to see if they were entitled to free school meals. ‘I put in for free school dinners and they said I wasn’t entitled. That was two weeks ago. At my daughter’s (secondary) school the head then said they would give her school dinners free for a little while.’ Her nine year old’s primary school told her that her son wouldn’t be able to get free meals.

Hayley believes that what’s making their situation so difficult is an assumption by HMRC that their income in this financial year is going to be much higher that the reality that is unfolding. Hayley is going to spend at least half of this financial year on sick pay or maternity pay, and her partner’s income as a self-employed person has plummeted recently. ‘HMRC is making assumptions about our yearly income that are not accurate.’

The couple haven’t been able to buy any Christmas presents this year, and the outlook for this lovely family as the holidays approach and the new baby is born is grim indeed. The food bank was able to help with the standard package of three days’ supply of non-perishable food including canned staples. But there were no nappies, wipes or baby-related material in stock that day. We were not able to provide any fresh food either, as the Trussell Trust food bank network is not set up to do this.

The day before I interviewed Hayley, I talked to the manager of the Trussell Trust foodbanks in Greenwich Alan Robinson. Earlier this year, Alan was called to give evidence to the All Party Parliamentary Group Inquiry on Hunger and Food Poverty in Britain. The inquiry report Feeding Britain was published last week with quite a fanfare, and the report was featured widely in the mainstream media, including The Guardian. Alan thought the report provided a ‘reasonable assessment’ of food poverty in Britain and its causes. He said: ‘It sets the scene and talks about food costs and how prices have increased since 2003 compared with other countries such as France, Germany and the US. It also shows how housing inflation and fuel costs are more here than in any of those other countries, and that income is less.’ The inquiry report pointed out how the effects are cumulative, ‘and the gap between managing and not managing gets worse every year and has proliferated since 2003. Post-2003, the effect has impacted on lower income people much more.’

Alan and his dedicated teams of volunteers at these food banks in Greenwich are doing their utmost to ease the plight of people caught without food and without enough income in this part of South-East London. After speaking to him and meeting Hayley and her family, I turned to the inquiry report in search of hope for the future for people like them – proud people who are dedicated, hard-working parents and find it humiliating to end up in a food bank a week before their baby is due.

I’m sad to say that I finished this report with little reassurance that things are going to improve. I really don’t doubt that the church leaders and other individuals behind it – including MP Frank Field and even Conservative peer Baroness Jenkin who apologised following the report’s launch after saying that ‘poor people don’t know how to cook’ – are well-intentioned and genuinely want to help tackle and even solve this very British problem.

But despite wanting to be optimistic, I was left feeling very disappointed. It heavily promotes ideas that are worthy enough in themselves such as redistibuting fresh surplus food (even though I have my doubts about there being substantial quantities of  local and usable food available to redistribute week after week), and points to the success of a ‘social supermarket’ model currently up and running in one town in South Yorkshire. It wants other areas identified where the model can be rolled out.

But the report’s central recommendation is for the creation of a new national network called Feeding Britain, composed of the food bank movement and other providers of food assistance, the voluntary organisations redistributing fresh surplus food, the food industry and representatives from ‘each of the eight government departments whose policy affects the numbers of people at risk of hunger’.

It recommends that the Government initially provides support to facilitate the setting up of 12 pilot projects – one in each UK region – to draw together ‘private, voluntary and public expertise to eliminate hunger’. Central to the overall success of this, it says, ‘is the local point of contact, perhaps called “Food Bank Plus”‘. It focuses on ‘fostering the co-location of services in a ‘reformed One Stop Shop/Food Bank Plus model, in which food assistance providers become an integral part of local hubs that help people out of hunger by addressing some of its root causes such as problem debt, addictions, access to benefits and difficulty coping on a low income’.

But the report seems to have little if anything to say about levels of UK benefits that the Council of Europe has slammed as ‘inadequate’. Deep in the separately published review evidence, there is a mention that the real value of child benefit across the decade to 2013 fell by £1.80 a week, and the real value of jobseeker’s allowance fell by £3.55 a week. The real value of the National Minimum Wage fell from £6.46 in 2008 to £6.19 in 2103.

While the report does say that a national strategy to tackle low pay is ‘essential’, it then strangely seems to pull its punches by saying that it merely ‘aspires to see household incomes at the bottom that are more able to absorb shocks without even greater support from taxpayers’. There is a fudge recommendation that the Low Pay Commission should be empowered to ‘set reference minimum wage rates in each sector of the economy… and for these powers to be used immediately to encourage higher minimum wages in sectors of the economy that can most easily afford them such as finance and banking’.

I did not see much evidence of the report attempting to address through the recommendations the real, cumulative impact of low benefits and other factors on UK disposable incomes, resilience when faced with a crisis, and on weekly food budgets. The other factors include – but are not limited to – zero hours contracts, high public transport costs, low levels of social housing and vast increases in self-employment. The inflexibility of the HMRC when it comes to adjusting work and child tax credits quickly when people’s life circumstances change did not seem to get a mention either. Neither did the main report really touch on the impact trends such as zero hours contracts and casual work in areas including retail and social care have on family life and routines and the time available to shop for and prepare food.

My conclusions about the report firmly echo some of those expressed neatly by Richard Bridge in this letter to the Guardian (it’s the second letter in the series). In it he says there’s a ‘real danger that the proposed solutions in the Feeding Britain report deflect from the political urgency of addressing the structural underlying issues of poverty’. He adds that ‘if the justiciability of the right to food is to be regarded as anything more than illusory, it is critical that we look upstream at addressing the adequacy of wages and social security’.

On free school meals, the report does recommend that the Department for Education prioritises poor children from working families in any future expansion of the free school meals programme. That’s a worthwhile recommendation. But will autonomous academies and free schools be equally interested in ensuring this happens? What will really happen on the ground to help poor children in both working and non-working families once the Conservatives slash school spending by a quarter (as the Liberal Democrats claimed yesterday).

I was also quite taken aback by the main report’s tone when talking about the victims of Britain’s culture of low pay, low benefits by international standards, and its increasingly low levels of social support as the public sector shrinks daily. Some of its references to food bank clients and what it sometimes refers to as their ‘lifestyles’ are at best paternalistic and at worst judgemental. Some of its comments seem to lack balance and empathy. Some examples:

‘…Evidence presented to the inquiry confronted us with the unpleasant truth that some children, we do not know how many, are hungry when they reach school because of the chaotic conditions in their homes. A large percentage of the primary schools that submitted evidence to the inquiry said they had witnessed children arriving at school hungry because their parents could not, or would not, wake up to make them breakfast, or bring them to the school breakfast club.’

The report continues:

‘But we should not leave the duty resting with schools. Parents have duties, and these duties are not abated by the chaos resulting from their lifestyle.’

It adds:

‘We recommend that schools should wherever possible refer such chaotic families to their local Troubled Families project, whose success can be measured in the number of families they have “turned around” to being functioning in the normal way.’

When talking about benefit sanctions, the report includes the comment:

“Some sanctioned claimants do not kick up a fuss because they may, for example, have been working on the side whilst claiming and see the sanction as part of the business plan of fraudulently claiming benefit.”

There is a certain narrative that is implied in this report of a benign state trying its best to rescue vulnerable families from the consequences of their own chaotic ‘lifestyle’ choices. A picture seemed to emerge of unfortunates with a hapless tendency to budget badly and get into debt. This bears little or no resemblance to the lives of the vast majority of the people I’ve interviewed in food banks here in London – including Hayley and her family. I would describe them as dignified, resourceful and resilient in the face of circumstances that are adverse in the extreme. Many have severe and long-standing physical or mental health (often a combination) issues for which the state is offering no support. Many are parked on below subsistence level benefits while they wait for work capability assessments that are often of highly dubious quality. It is hard to see how their health can do other than get worse in this situation.

The evidence review does helpfully feature a number of case studies and personal testimonies, including oral evidence from anti-poverty campaigner Jack Monroe and other submissions from food bank clients. I was also pleased to see that it  included two accounts of  client experiences from a number that I submitted to the inquiry myself . But I would have welcomed much more of an attempt to give a clear voice in the body of the report to more of  the individuals forced through no choice of their own to turn to food banks. After all, they are there because, as Richard Bridge says in his Guardian letter, their right to adequate food, as rooted in the Universal Declaration of Human Rights, is being disregarded.

If the severe economic crisis that the Bank of England has stress tested for does materialise in 2015, is the roll-out of a regionally-focused ‘Food Bank Plus’ network being quickly designed as a first-line defence against widespread hunger and food poverty?

There are many individual laudable ideas here. But this report does not pretend to be a serious attempt to fix the deep structural causes of growing inequality in Britain and to be fair to the inquiry team it wasn’t set up to do this.

To help the core group of people who seem most in need of the food banks in this part of London, what we require are benefits for those who really need them that are set at a level that might meet people’s most basic of needs – ie for food and shelter. We also need a reversal of the current rapid disinvestment in the public realm. We need the sort of high-quality truly joined-up public services – including health and well-being services – that could really revolutionalise lives across the generations. Cooking classes, help with making depleted budgets ‘stretch further’ and debt counselling – however well-intentioned – just will not provide a long-term and sustainable solution.

Tragically, the most vulnerable people continue to be increasingly marginalised and scapegoated by the Government. Its judgements and attitudes towards those least able to defend themselves are being mirrored by another group of citizens who know that they and their children are also being left behind economically and by society. We live in dangerous times.

 

Greenwich food bank manager tells APPG: No-one at job centre understands the system

Greenwich food bank manager tells APPG: No-one at job centre understands the system
Manager of Greenwich food bank Alan Robinson, who gave evidence to the All Party Parliamentary Committee on Hunger and Food Poverty
Manager of Greenwich food bank Alan Robinson, who gave evidence to the All Party Parliamentary Committee on Hunger and Food Poverty

The manager of  the Greenwich food bank Alan Robinson has been particularly busy recently. Not only is food bank use up by a very worrying 500% in Lewisham and Greenwich, but last week he was called to  a Westminster evidence session of  the All Party Parliamentary Group on Hunger and Food Poverty. This APPG  is proactively investigating the underlying causes of hunger, food poverty and the huge increase in demand for food banks across Britain. The group was established by MP for Birkenhead Frank Field, and he is co-chair, alongside the Bishop of Truro Frank Thornton.

The inquiry was launched in April this year at Lambeth Palace, with the aim of posing a series of key questions to each of the political parties in the lead up to the next general election about how they will respond to the rising demand for food aid in this country. Mr Field brought evidence to that first formal session about how some of the conventional trends in households’ ability to cover the cost of living had been “shattered over the past decade – with the proportion of household incomes needed to cover the combined costs of housing, fuel and food increasing since 2003”.

The terms of reference include understanding the extent and geographical spread of hunger and food poverty in this country, its causes, and investigating the source of emergency food assistance providers’  supplies. Some of the other terms of reference include the effectiveness of emergency food assistance in meeting immediate and long-term needs , and the possibility of these schemes becoming permanent features of the welfare state. The full terms of reference  list is here. The inquiry will also make recommendations, and a report is expected in the autumn. You can follow the work of  the inquiry by visiting www.foodpovertyinquiry.org

Alan was one of the people called to a closed hearing evidence session in Parliament last week. The inquiry has already held regional evidence sessions in Birkenhead, Salisbury, Cornwall and South Shields. Alan reported back to me on what he said at the session. He had written to the inquiry, telling Mr Field about the Trussell Trust food bank in Greenwich. He described the vast growth in numbers which he attributes to the welfare changes which began in April 2013, including the welfare cap and the bedroom tax .

He said: “The inquiry already had a good understanding of  some of the issues, and they asked me to clarify some of the issues I’d written about. There are problems at the job centre (one of the places that can refer people to the food bank for help). No-one understands how the system works – not even the people who work there. Then they don’t apply the system consistently. The job centre is a daunting place to visit. The government makes the rules and then doesn’t tell everyone what they are. The job centre loses documentation – but then that loss becomes your problem as a client. It’s the attitude of ‘none of these problems are our problems, even if we’ve caused it’  that comes with it. Lost documentation is a key example.”

The inquiry heard of the cafe-style approach at the Greenwich food bank, where people can be helped in a compassionate, caring way. This led to a discussion with the inquiry panel about whether state institutions can be compassionate. “It’s not a quality you would nowadays attach to state institutions – to be compassionate and show empathy. To do that you have to listen. People tell us ‘it’s no good telling them anything – they don’t listen’.”

Alan told the inquiry that a number of clients “don’t have the capacity to advocate their own position”. A representative of  the East London based Tower Hamlets food bank was also giving evidence at the session, and “what came out in both of our evidence is there’s a section of clients who need someone to provide advocacy”. Alan told how he hears people’s stories, “and contacts the agency or department concerned and often gets results – if Greenwich food bank is calling up the job centre then that has a greater impact”. The panel then went on to discuss whose role it is in society to provide that service.

Someone needs to be doing this vital advocacy work, says Alan. “If you took away the need for me to provide food, then I would be quite happy to do it.”

Advocacy seems to be the missing link in many lives. Vulnerable individuals who get the right timely support may be able to avoid hitting crisis and needing an emergency supply of food – in the same way that someone with a chronic illness may avoid a costly hospital intervention with the right specialist support in the community. A professional advocate  – a housing support worker, a community psychiatric nurse, a social worker or a Trussell Trust manager freed up from the need to source and provide emergency food could very often help to get someone’s benefits sorted at tribunal or get a sanction lifted. But how many professionals are left with the time to do this work?

There’s a growing group of vulnerable people in the UK who are losing their way in a fast-changing and complex welfare system that seems designed to confuse. Fewer and fewer people are being paid and trained to help them. The result? In Greenwich, visitors to Trussell Trust food banks increased from 776 to 5,025 in the past year, while the figure rose from 623 to 3,895 in Lewisham borough.

Having reported from the Greenwich food banks for nearly a year now, I’ll be submitting some evidence this week to the inquiry team – based on some of  the individual interviews I’ve carried out with clients. The deadline for submitting evidence has officially passed, , but you can still email submissions to Andrew Forsey, joint secretary to the inquiry team on andrew.forsey@parliament.uk

If you are able to structure your evidence according to the terms of reference, this will help the inquiry team to analyse the large amount of evidence it hopes to receive.

Alan has written to work and pensions secretary Iain Duncan Smith on Twitter, inviting him to visit the food bank. He hasn’t received a reply yet. London Assembly member Len Duvall has also called on London Mayor Boris Johnson to pay the Greenwich food banks a visit.

 

 

 

 

Can England’s A&E units spot the malnourished? Mark’s story revisited

Can England’s A&E units spot the malnourished? Mark’s story revisited
Mark Bothwell, who's on jobseeker's allowance. He says he hasn't been eating properly for years.
Mark Bothwell, who’s on jobseeker’s allowance (JSA). He says he hasn’t been eating properly for years.

Mark Bothwell (above) came into the London food bank today. He’s had a painful problem with his shoulder for some time that leaves him unable to accept many types of physical work, and he also has depression. He’s been waiting for months for his claim for employment and support allowance (ESA) to be processed. Not that this 29-year-old is likely to be better off financially by transferring over from JSA, but he would at least be relieved of  some stress. He says: ‘It’s a job-stopping illness, so the positive thing (about changing benefits) is not having to worry about job hunting.’

Last week, he described two recent trips to the accident and emergency (A&E) unit at the local hospital – the Queen Elizabeth in Woolwich. He says that terrible chest pain drove him to seek help, and that a viral infection causing inflammation of the outer lining of the heart was suspected. Mark, who is already on strong medication prescribed by his GP for his shoulder pain, had an adverse reaction to one of the medications given at the A&E. It upset his stomach and caused ‘a lot more pain’. This extra pain meant he had to make a second visit to A&E later that week. While the doctors took a family history during his visits to cover heart issues, and did blood tests, an ECG and X rays, he says the doctors didn’t ask about his circumstances. ‘They didn’t ask if I’d been eating properly for the last few months. Actually, I’ve not been eating properly on and off for years. Money has come and gone for years since I moved out of the house at 21. I was homeless for 18 months. Although I’ve had the foodbank vouchers, which has been good – it’s not been enough to cover the last four months. Even during this time (when he’s had some help from food vouchers) there have been a couple of days when I’ve not been able to take my pills because I haven’t had enough food.’ He says that recently, when he hasn’t had enough food, ‘shoplifting has crossed my mind, and this is how desperate people can get’.

Why didn’t  the doctors in A&E ask him about his circumstances, which may have flagged up the effect poor nutrition for many years could be having on his health? Could it be because the A&E unit, like many in the NHS in England, is understaffed and generally in crisis? The hospital is part of the Lewisham and Greenwich NHS trust, and this week health inspectors the Care Quality Commission published a report that was highly critical of many aspects of services at the trust, which it says requires improvement. The A &E unit at the Queen Elizabeth is deemed to be inadequate, and ‘not fit for purpose’. The inspectors, who visited the hospital in February, have serious concerns about the safety of A&E services there . They note a shortage of beds for admission to the hospital, causing a block in the system, particularly for patients in A&E. Ambulance personnel told inspectors there were regular delays in booking patients in and patients often had to be treated in the back of ambulances. They also pointed to the low staffing levels in A&E, with 29 full-time equivalent nurse vacancies and vacancies for four consultants and six junior doctors. The report also says that since the closure of the accident department at the nearby Queen Mary’s Hospital  in 2012, attendances had risen from around 300 to over 450 a day. Because of a lack of space, patients who ‘would have benefited from being able to lie on a trolley or bed were having their treatment on a chair in full view of other people’. Against this background, do the A&E staff  have the time to take detailed enough case histories?

Mark’s  food budget of about £2 a day and spells without eating adequately over many years must be impacting on his health, yet none of the doctors treating him in hospital asked him about his nutrition.  Is the NHS really capturing the facts about how many people are becoming ill, or having their health conditions made worse because of malnutrition and food poverty? The steep upward trend in the number of people being driven to use food banks indicates a rise in the number of individuals and families struggling to eat well. But as the Faculty of Public Health so clearly points out, actual food bank numbers are ‘an inadequate indicator of need, because many households only ask for emergency food help as a last resort’. So the true scale of food poverty remains hidden.

In Wales, hundreds of patients have been diagnosed with malnutrition in the past few years. New figures from a Freedom of Information Act request show 1,229 patients have been diagnosed since 2007/08. In England, primary and secondary diagnoses of malnutrition in hospitals rose from 3,161 in 2008/09 to 5,499 last year, according to figures released by health minister Norman Lamb. In November 2013 an early-day motion in the House of Commons from MP George Galloway noted a ‘doubling of the diagnoses of primary and secondary malnutrition in Bradford Teaching Hospitals NHS Foundation Trust in the years 2010 to 2013 compared to 2008 to 2010’.

Are all cases of malnutrition as a primary or secondary diagnosis being clearly identified, given the levels of understaffing and the workloads in some A&E units?  What information is being gathered by GPs? These are issues the All=Party Parliamentary Group on Hunger and Food Poverty may want to start examining closely during its inquiry.

The outlook for Mark this weekend is more positive, and he didn’t need a food voucher this week. His MRI results show a frozen shoulder, and he’ll be referred for physiotherapy by his GP.  Mark is relieved that he doesn’t need surgery, and he’s been told he should receive a letter within 10 days telling him when he’ll start receiving ESA payments. He’s finally got an appointment to access  group pain management talking therapy, which will take place once a week for 10 weeks. The depression is still there, but is ‘starting to feel a lot better’.