Section 2: Economic inequality in Gateshead

Reducing health and social inequalities is not just a matter of fairness and social justice. Inequalities are bad for everyone in society. In unequal countries; civic participation decreases, household debt rises, and child well-being is worse. It is morally unacceptable that there is a direct link between lower social position and poorer health. In line with other parts of the UK, inequalities have started growing again in Gateshead. (Gateshead health and Wellbeing Strategy: Good Jobs, homes, health and friends)

In our economically advanced society, rising inequalities suggest that the right policies are not in place to make use of all available resources to guarantee a decent standard of living for everyone.  

The country has had over ten years of austerity which has seen public sector funding continually reduced by central government - we have lost nearly half of our previous funding, the equivalent of £900 less to spend per year on every household in Gateshead. Austerity has resulted in a significantly reduced universal and preventative service offer which, combined with a growth in the older population alongside the local impact of welfare reform, has produced an increase in demand for more expensive crisis services. Intervening late is morally wrong, but it doesn't make economic sense either, as it leads to poor outcomes for individuals and escalates that overall cost. (Gateshead health and Wellbeing Strategy: Good Jobs, homes, health and friends)

The combination of austerity and increasing need has meant it has become ever more difficult for all services to respond with the help and support people require. In this context closing the inequality gap is an even bigger challenge which will need us to look beyond ill health treatment and social care services. The most effective way of ensuring people have the best chance of thriving is to make sure they have a good education and access to good quality work and enough income to meet their needs.  

In May 2017 the Gateshead Homelessness and Multiple and Complex Needs Health Needs Assessment (HNA) (Gateshead Homelessness and Multiple and Complex Needs Health Needs Assessment - May 2017 (PDF, 4 MB))  highlighted the strong overlap between homelessness and other support needs such as substance misuse, physical and mental ill health, cycles of physical and emotional abuse and involvement with the criminal justice system.

Homelessness is evidence of inequality and is a late marker of exclusion and disadvantage. Current evidence suggests that homelessness results from the impact of structural, institutional, relationship and personal risk factors and triggers which have a cumulative impact and are often underpinned by poverty and structural inequalities. 

The prevalence of problematic childhood experiences among those with multiple and complex needs points to a need for improved understanding within services of routes into multiple exclusion homelessness and earlier targeted work with children who are experiencing issues that may relate to later homelessness. (Tackling homelessness and exclusion: Understanding complex lives.)

The HNA identified evidence to suggest that our current system is weakest where it needs to be strongest. The way services are funded, commissioned, monitored and measured often requires homeless, vulnerable individuals with multiple and overlapping needs to navigate a complex system that requires them to engage and manage relationships with numerous different agencies simultaneously in order to address their needs.

Homelessness is not just a housing issue

Catherine Hattam, The Gateshead Housing Company

"Any contact made by a potential client needs to be regarded by all services as an opportunity to meaningfully engage with that person. The contact should be used to identify signs or triggers which may indicate that a household may be at risk of homelessness."

As agencies, we come into contact with individuals and families at different stages and all have different triggers such as truancy, debt, multiple visits to A&E, offending history and referrals into children services. The trigger points should be used as opportunities to identify potential early intervention options to prevent homelessness.

The system in which we all work continues to create barriers for individuals and families who try to access services before crisis point. We have a culture of 'assessing clients out' of the system, rather than into services. Essentially by identifying why we cannot help rather than looking at how we can help.

By failing to use the opportunity of a contact, to see the person and take a full account of their needs and wants, we risk missing an opportunity to support people earlier (at a preventative stage) and instead, when things deteriorate, we end up responding to crisis contacts.

Unless we truly see the person from a holistic perspective and understand the root cause of the presenting issue or crisis, we will only continue to "patch up "and move them on until the next crisis. The Homelessness team are working hard to consider our approach to addressing some of these challenges and review how we work across the council.

The Gateshead Housing Company (TGHC) was successful in securing national funding for a 'Somewhere Safe to Stay Hub' for rough sleepers. The hubs provided an intervention tool to end rough sleeping. The Hubs allowed us to rapidly assess the needs of people who were sleeping rough and those who are at risk of sleeping rough and support them to get the right help quickly.

In the same round of funding, TGHC was also successful in securing funding for seven additional units of 'Housing First' accommodation for clients at risk of rough sleeping. 

This funding helped TGHC to continue to work in partnership with Oasis Community Housing to increase the capacity of their Basis Beds (Housing First units) to assist more clients at risk of homelessness and rough sleeping.

The Housing First (Housing First) approach is about doing things differently. It is an internationally evidenced based approach which indicates that individuals experiencing multiple disadvantage are more likely to lead fulfilling lives if they are provided with a stable home and good quality, open ended, support.

Although in its early stages some of the work we are doing on homelessness has started to give us a picture, of the broader reasons why, certain households lose their home end up in the worst form of homelessness, rough sleeping.

The approach taken with this client group has allowed staff time to get to know the clients and build a picture of their lives prior to becoming homeless. There are common themes of adverse childhood experiences, domestic abuse, sexual and physical abuse and a history of care. This knowledge brings an understanding of the true nature of homelessness and why it occurred, which then can help to create solutions. The solutions required are more than just bricks and mortar, to be effective they need to address the underlying causes.  

Mandy Cheetham, Embedded Researcher 

It is the role of the Director of Public Health to understand how national policy is impacting on local people and to capture evidence of that impact and its health outcomes. Gateshead Council was a pioneer and early adopter of embedded research as a promising way to integrate evidence into public health practice. (. Cheetham M, Wiseman A, Khazaeli B, Gibson E, Gray P, Van Der Graaf P, Rushmer R. Embedded Research; a promising way to create evidence-informed impact in public health, Journal of Public Health, Volume 40, Issue suppl_1, 1 March 2018, i64-i70, https://doi.org/10.1093/pubmed/fdx125 (opens new window)) This work has ensured that we understand and hear the voices of local people as well as looking at the reported statistics.

A place-based, community-led study undertaken in 2017 in an area of East Gateshead which faced significant inequalities, identified community members' concerns about the forthcoming roll out of Universal Credit (UC). Senior managers and leaders in Gateshead Council were keen to understand the health and social impact of the government's new policy to 'simplify the benefits system' and 'encourage people in to work'. The study was commissioned by public health to examine the impact of UC on community members and staff. A research team from Teesside University and Newcastle University interviewed 33 UC claimants and held interviews and focus groups with 37 staff supporting them.

The findings were a stark wake-up call and made for harrowing reading. The research showed the profoundly detrimental impact which UC was having on vulnerable claimants, including people with long term health conditions and disabilities, their financial resilience and employment prospects. The UC claims process was experienced as complicated, difficult to navigate, hostile and demeaning. The wait for payment of five to 12 weeks pushed many into debt, rent arrears and reliance on foodbanks, increasing the shame people felt. 

The impact was so severe that some claimants said they had considered suicide.

One claimant felt UC "cuts the feet from under you at a time when you need it most". Concerns about the increased risks of poverty and destitution among vulnerable claimants were voiced by staff and placed additional pressures on the wider health and social care system.

The research was published in an exclusive in the Guardian (The Guardian. Exclusive: universal credit linked to suicide risk) and in an academic paper. (Cheetham M. Moffatt S. Addison M. and Wiseman A. (2019) Impact of Universal Credit in North East England: a qualitative study of claimants and support staff, British Medical Journal Open:9:e029611. doi:10.1136/bmjopen-2019-029611) 

Members of the research team met with Phillip Alston, the UN Special Rapporteur on Extreme Poverty and Human Rights, who cited the research in his final report. (Alston P. et al (2019) Report of the Special Rapporteur on extreme poverty and human rights on his visit to the United Kingdom of Great Britain and Northern Ireland) Local and national press coverage followed, including radio and TV interviews with the Director of Public Health in Gateshead.

A presentation to Gateshead's Health and Wellbeing Board in January 2019 prompted a jointly signed letter outlining concerns to be sent to the then Secretary of State for Work and Pensions, Amber Rudd, but received no response. The research team, meanwhile, continued to receive emails from claimants and staff across the UK highlighting similar concerns. 

Having submitted written evidence to the Work and Pensions Select Committee enquiry in to the five week wait for Universal Credit in Feb 2020, Mandy Cheetham was invited to give evidence in response to MPs questions alongside a colleague from Liverpool University on 16 June 2020. (Cheetham M. (2020) Evidence to Work and Pensions Select Committee enquiry on the Impact of the Five Week Wait for Universal Credit, Wednesday 17 June 2020)

In July 2020, the work and pensions secretary, Thérèse Coffey, announced changes to the ways vulnerable claimants are to be treated by DWP.

"In academia, we are encouraged to think about the impact of our research, but rarely is the complexity of this process acknowledged. Co-located, embedded research (ER) has enabled me to build trusting relationships with colleagues in local government and VCS organisations. Together we have explored the possibilities of different ways of working. ER has opened my eyes to the possibilities and challenges of using evidence to inform policy and practice in situ. I have gained enormously from being rooted in different bits of the system in which evidence is used, seeing how people and systems interact, working alongside community members facing the greatest inequalities. I am enormously grateful to those who shared their lives and for the opportunity to investigate the effects of government policy, and share these at local, national and international events. Valuable moments have been created to share insights and affect change, frustratingly slowly and in small ways."
Mandy Cheetham, 2020. 

In November 2019 Citizens Advice Gateshead, Tyne and Wear Research and Campaigns Cluster Group published a paper examining the barriers in claiming Universal Credit and the effect on Claimants' finances during the five week wait for their first Universal Credit payment. (Impact of claiming Universal Credit. 2019 (opens new window))

The report showed that many people who are on Universal Credit struggle to manage their money or cover essential costs, particularly during the  five week wait for their first payment. Whether making a new claim for Universal Credit or migrating from 'legacy' benefits, the trigger for making a claim is often a disruptive change of circumstances, such as losing a job or breaking up with a partner. Therefore, getting the support and timescales correct between making an application for Universal Credit and the claimant receiving their first payment is crucial to the success of Universal Credit and reducing the financial impact upon claimants.

The report reflected the experience of claimants in Gateshead for whom it was reported, in evidence to the All-Party Parliamentary Group (APPG) on: The Economics of Universal credit (Feb 2020) (APPG on: The Economics of Universal credit (Feb 2020)) that: 

Since April 2019 Citizens Advice Gateshead have supported 3,416 people with Universal Credit issues.

• The majority of clients attended seeking help with their initial claim (73%), most of whom came to simply make sure they're  in dealing with priority debts, such as rent, council tax and utility arrears.
• one in four of those seeking help with their initial claim, 527 people, were struggling to manage their claim due to limited digital literacy.  
• A significant proportion of the clients attending our drop-in service needed our help dealing with deductions and sanctions to their payments (11.9%, 407 people), and many of those needed further help from us through financial crisis, such as food bank access and advice in dealing with priority debts, such as rent, council tax and utility arrears  

Citizens Advice Gateshead state that 'in our experience UC can be a good system for many, but it is still causing problems for a significant number of claimants, and we feel this needs to be addressed'.

In 2019/20 Citizens Advice Gateshead provided support to 57,901 clients across a range of issues. Their clients come from all age groups and family circumstance but share the same challenges: problems with benefits, debt and universal credit. 

Gateshead Poverty Truth Commission exists to ensure that people who have experienced poverty first-hand are at the heart of how Gateshead thinks and acts in tackling poverty and inequality.

We are made up of 'experts by experience' of poverty. Together we are building relationships with people who hold power in Gateshead. We'll listen to and work with each other to tackle the causes and effects of poverty in Gateshead.

We believe that the only way to make change is to include the real experts in decision making. We believe "nothing about us, without us, is for us".

Marie's Story - listening to communities

I live in Highfield with my family. This part of Gateshead means the world to me. It's the best place to live with the countryside right on your doorstep. But it's been a hard over the last few years for this community. Sometimes it feels like everything has been taken away from us.

A healthy community is one where everyone looks out for each other and makes a difference. But everyone has to be involved to make a community work at its best. People have lost their hope and trust in the people who make decisions. The only way to get that back would be to be actually listened to, not just to have a talking shop.

My dream for Highfield is that it would have a community centre where everyone no matter their age could be together and have their voices heard.

Gateshead Poverty Truth Commission is a way for me to make sure people's voices are actually listened to when decisions are being made about their community. 

Paul John's Story - listening to voices of lived experience

I came to the PTC with four years' experience of mental health problems and poverty. I've been through different benefits and have experienced relapses in my mental health as a result of the pressures and stresses of the benefit system.

I joined the PTC because it uses those life lessons to educate and build awareness about how systems affect people - in my case the systems surrounding mental health and poverty.

In my opinion decisions that are made purely with statistics can be dehumanising because they undermine the true impact on individuals and families of policies around poverty. Prior to being a member of Gateshead PTC I felt I had an understanding of the effects of poverty on me and others like me but no outlet to talk about it or make change. The PTC has allowed me to express honestly those experiences to a listening audience.

I would hope that the use of life experience stories will become part of normal decision making in Gateshead and beyond. Not just as a box ticking exercise but to affect decisions that impact people's everyday lives. 

Future ways of working

The conversations that we have had with local people, which is evidenced in these case studies, highlights the need to find ways to work alongside our community and develop a participatory leadership model that allows local people to truly influence future direction and policy for their local area.

The clear message from the work of the Poverty Truth Commission, the insight around universal credits impact and the day to day work of partners shows that we can only move forward in partnership with local residents, who know, by experience what will work best for them. 

The economy is identified as a key priority in our refreshed health and wellbeing strategy. While Gateshead's economy has grown in recent years and increasing numbers of residents have moved into employment, we know that opportunity and prosperity are unevenly distributed across the borough, which is unsustainable.

For too many, recent employment growth has been precarious; some jobs are out of reach, whereas other roles do not offer enough hours, pay or progression to support households and families. As a result, there are few incentives for residents to improve their skills and earning potential or pursue self- employment.

These trends are contributing to declining living standards and producing enduring and rising inequality. The economic and social cost: long hours; problem debt; family breakdown, poor health, and crime fuel insatiable demand for crisis support. As people struggle to find work or toil more for less in growing numbers, the council can no longer raise enough revenue to heal the harm. Austerity has compounded the problem - increasing the scale of the challenge - while reducing the funding of vital intervention.

There is scope to nurture an environment that encourages new businesses to start up and grow, create more good jobs, and ensure our residents have the knowledge, skills, and confidence to get on at work instead of struggling to get by.

We want Gateshead to be a place with a flourishing economy that enables everybody to achieve their full potential. Preventing Gateshead residents from getting stuck in poor quality employment, removing the working poverty trap, and making self-employment a viable option for local entrepreneurs are essential to a thriving economy and better future for the borough.

Gateshead is supporting local regeneration by helping people to gain new skills, get back into work, start their own business or repurpose community assets to improve local wealth. Self-employment can be a good option for people who want to generate their own income or run a business. The New Enterprise Allowance programme provides someone with either a mental health or physical disability to establish an enterprise to suit their needs. 

"I am a 41-year-old man who worked from the age of 15 until I suffered a traumatic brain injury at 36. I had always dreamed of working for myself; alongside my full-time job, I had several ventures buying and selling new and used products on eBay.

Now that ongoing health issues affect my everyday life, I figured going back to a structured 9 to 5 job would not work for me or an employer. This rekindled interest in working for myself.

Via the Job Centre, I discovered the New Enterprise Allowance programme, which helps people on benefits to start their own business. It has truly been the best thing that could have happened to me. Before I was put in touch with Carol, all doors to any help had seemed shut and double locked, but she worked patiently with me throughout the business planning process to ensure I was accepted onto the scheme. I was given lots of written information that I could read and refer to because Carol understood that my brain injury had left me with memory issues. She has stayed in touch and helped to promote my used furniture business. 'Horizon Furnishings' continues to grow steadily, and with Carol's, help I hope to expand in the near future."

Securing investment in Gateshead is fundamental to improving the quantity and quality of local employment opportunities. One of the ways to achieve this ambition is through our capital programme, which brings together public and private investment to build the homes, workspaces, local amenities, and infrastructure our communities need to thrive. This activity is expected to create thousands of job opportunities between now and 2030.

Major schemes in the pipeline starting in 2021 include:

• The £260 million development of Gateshead Quays, including a 12,500-seat arena, conference and exhibition centre, new hotels, green spaces, and improved links to Gateshead town centre, generating over 1200 jobs.
• Bringing forward land to develop 225,000sqm of industrial and distribution space that will provide up to 1,500 jobs in the distribution, logistics and manufacturing sector. As a designated Enterprise Zone, Follingsby has benefited from essential infrastructure necessary to facilitate commercial development of the site.

The council has a strong track record of using its influence and powers to generate community benefits from development taking place across the borough. Expanding the range of employment and training opportunities available to Gateshead residents is a prime objective. These outcomes are achieved by the council working collaboratively with partners and employers to enable the hiring of a diverse local workforce.

As well as creating more and better quality jobs, readiness for employment is essential if residents are to benefit from future opportunities, particularly those furthest from the labour market. This can require intensive employability support over several years, so long-term forward planning is essential. 

Skills brokerage and employability support is provided to help unemployed or economically inactive residents to access training and employment opportunities with companies investing in the borough or overcome multiple barriers to work. As residents begin to reap the financial benefits of moving into employment, the increased money they spend locally helps to support businesses, retain jobs, and reduce demand on public services.

Employability and job coach case study

Employment support that has enabled an individual disadvantaged in the labour market to find and sustain work.  

Understanding

A lack of recent experience, low confidence, and a belief he was too old to be employed led to David thinking he could never find work again. He had been made redundant two years ago from a job he had been in for 15 years. The redundancy resulted in long-term unemployment and left David feeling rejected. He became a recluse in his own home, had no self-worth or self-esteem and began to suffer from ill health, gaining a substantial amount of weight and a diabetes diagnosis.

A Job Coach with David and she met with him at home where he felt safe. After the first three appointments, he agreed to leave the house to walk to a local coffee shop accompanied by his Job Coach. After six weeks David felt able to travel there alone. He started looking forward to the meetings and began shopping in the store where the coffee shop was. His diet improved as he purchased fresh food to cook for himself and no longer lived on takeaways. The Job Coach helped him access counselling to improve his mental health and travelled with him to his first session. Working with his Job Coach he began to realise he was the only one stopping himself from moving forward.

Work as a reality

David's Job Coach found a vacancy with a local charity for a driver, but David was reluctant to apply for the role as he believed his age would let him down. After encouragement, he applied and was invited for interview within a week. The Job Coach secured funding for interview clothes and set up simulated interviews to provide him with experience of answering questions from people he didn't know.

David was offered the job but felt two barriers prevented him from accepting it- what to wear at work and who to call on for help if he needed it. Work clothes were organised by his Job Coach and fortnightly phone calls booked in the diary. David really enjoys his job. His relationship with his family has improved and he does not worry about leaving the house, he is losing weight, and has finished his counselling sessions. He now feels he is now in control of his life." 

Most business and employment support programmes designed to meet the needs of Gateshead residents rely heavily on external funding streams, which are soon coming to an end. Interventions tailored to local conditions are vitally important to improve the health of the population and the economy. They enable us to pioneer and scale up successful activities that deliver positive outcomes for the borough's residents and businesses. Very often these initiatives fill gaps in provision, particularly those who are disadvantaged because of their background, experience or circumstances.

We know how important it is to give people the power to make the most of their money and their lives, to give people a fair chance and reduce the stress faced by people moving between benefit entitlements and work. An essential part of this is to tackle inequality so people of all ages have a fair chance and receive an income sufficient for healthy living. Like most other countries around us, the UK has voluntarily subscribed to international legal standards that declare that everyone is entitled to an adequate standard of living, including healthy food and decent housing. (Gateshead health and Wellbeing Strategy: Good Jobs, homes, health and friends) 

Section 3: Social inequalities