1. Welfare Reform, health and the NHS in Scotland Kate Burton NHS Lothian and Scottish Public Health Network

2. "the most ambitious, fundamental and radical changes to the welfare system"

3. Reform of the welfare system Welfare benefits system is too complex Welfare benefits system is too expensive (cuts totalling £18 billion 2011-14)

4. ‘...the only thing that really beats poverty, long-term, is work’

6. Work, wellbeing and health Work is generally good for health and wellbeing Returning to work can lead to rapid improvements in health You don’t have to be 100% fit to work Good work is safe, fair, secure, fulfilling, supportive and accommodating

7. ‘No longer will it be possible to be better off on benefits than in work’

8. Reform of the welfare system Employment Support Allowance Tax Credits Consumer Price Index Housing Benefit Local Housing Allowance Benefit Caps Child Benefit Income Support Council Tax Social Fund Sure Start Maternity Grant Disability Living Allowance Universal Credit Passported Benefits

10. Housing benefit: under occupancy rules 82,500 households affected, 80% disabled 68,500 under-occupying by one bedroom; only 20,000 one bedroom properties available Impact of debt on physical & mental health Impact of homelessness on health Impact of DHP on primary care

11. Disability Living Allowance / Personal Independence Payment Timescale Application process Reassessment process 36% to lose out

12. “Our reforms are ushering in a new culture of conditionality and the claimant commitment lies at the heart of this”

13. ‘We’re all in this together’ George Osborne

15. The Hardest Hit Workless households and those in low paid work of more than 16 hours per week Households with children Lone parents (90 per cent of whom are women); possibly also women in couples Larger families Disabled people and those with long term health conditions

16. ‘…the welfare cuts (and in real terms, it is a cut) does not just affect some mythical group of immoral workshy scroungers. It affects people who are working – who are, in the political lingo, doing the right thing and playing by the rules. Poorer people are facing destitution, perhaps a decade of destitution, felt by future generations.’ Julia Unwin, chief executive, Joseph Rowntree Foundation (2012)

17. Challenges for the NHS – primary care, diagnostic testing & prescribing Increase in health inequalities Poorer mental health Increased cardiovascular and respiratory illness Poorer nutrition and increases in diabetes, arthritis and cancer Child protection & violent crime Sexual health

18. I cannot address medical issues as I have to deal with the patient’s agenda first, which is getting money to feed her family and heat her home.’ (GP’s at the Deep End, 2012)

20. Monitor impact Staff training & awareness Financial assessments & referral Partnership working Workforce planning & support Strategy dev & service delivery Employability actions

21. Thank You kate.burton@nhslothian.scot.nhs.uk