Dr Manu Savani – Written evidence (FPO0070)

Dr Manu Savani [1]

1. I thank the Committee for the opportunity to make a submission on the important questions of food insecurity, inequality and public health. In this submission, I draw on my experiences working with Barnet Local Authority public health officials during 2018, when I supported field research to develop a Needs Assessment and Action Plan on food insecurity in the borough[2]. The fieldwork involved three focus groups comprised of 14 individuals in total. The participants were professional staff working in frontline roles and community food aid organisations in and around the borough. The discussions took place during May 2018. Insights and excerpts from these conversations are summarised below against five of the questions posed in the Call for Evidence. Some of this information was submitted to the UN Special Rapporteur Prof Philip Alston in September 2018[3]. Barnet’s Food Security Action Plan is expected to be published by the Barnet Health and Wellbeing Board in October 2019.

In response to Qu 1: What are the key causes of food insecurity in the UK? Can you outline any significant trends in food insecurity in the UK? To what extent (and why) have these challenges persisted over a number of years? 

2. I asked welfare professionals employed by the Local Authority (LA) and staff from community food aid organisations about their day to day work, and what factors they associated with the food insecurity they had observed. Several respondents mentioned a web of issues around welfare reform, individuals having to deal with lower household incomes, vulnerability around housing, and the difficulty in balancing pressing financial obligations. These factors were inter-related, complex, and often triggered by other crises or unforeseen events. They were closely related also to mental and physical health, and the ability to cope with shocks.

3. Specific welfare reforms that were identified as having contributed to these difficulties included the benefit cap, the bedroom tax, and Universal Credit which at the time had just begun to be rolled out.

“Because of the change in benefit, housing benefit and other benefits, they’re struggling; they then face eviction, and we’re having to get involved. And that also leads to them not having food, and we have to give food vouchers out, which wasn’t something that we did up to a few years ago…”

“…People come and say ‘I haven’t eaten for three days.’ And you know they haven’t, you go in there, the electricity is not on, all the kind of basic things that everybody should have [are] not there, and they literally have got no money. It’s not because they’re living in any kind of lifestyle, where you’re thinking ‘oh because you’ve spent this much money on drink or cigarettes’. By the time they’ve paid the other bills they just don’t know [what to do]. They think ‘what do I do first?’ It’s like, you always say to people ‘pay all your utility bills’ but then they still don’t have any money for food. So we have to give out vouchers.”

“So housing benefit stops, well hopefully you prioritise paying your rent or other bills, you start to go hungry, so we see you at a food bank. Lots of government welfare initiatives, the benefit cap, leads to lots and lots of people experiencing food poverty. The bedroom tax, the freezing of welfare, not raising it along with inflation… [we are] trying to help people in those problems to stop them escalating into homelessness or crisis.”

“Universal Credit has messed up a lot of people… people used to get their rent paid and then, you know, used to get their other benefits separately. So they always had a roof over their heads.”

4. The causes of food insecurity can be best understood by taking a holistic view of multiple kinds of poverty and deprivation. The two-way association between mental health and food insecurity was a recurring theme in discussions. Vulnerability to facing multiple crises including poor mental health and food insecurity was traced back to public spending decisions. Cuts to local services were identified as having directly or indirectly affected food security. One respondent described the ‘meals at home’ service, which was cut by Barnet, with a sense of loss because it was an important way of ensuring vulnerable individuals had at least one nutritious meal per day. Others mentioned:

“As cuts to things like social services, mental health services start to really take away some of the essential need that people have, you just meet more and more quite desperate individuals that you might not have met five years ago. Or if you had met them five years ago, you’d have been able to get them help from a statutory service. Right now it’s a real struggle.”

“…housing, lack of support in mental health, and education probably is related to food poverty as well. Everything relates to that issue somehow, at some point, and links with it. And it’s a result of the whole picture.”

In response to Qu 2: What are some of the key ways in which diet (including food insecurity) impacts on public health?

5. There was a strong level of agreement in these discussions that the experience of hunger and food insecurity will have mental, physical and social effects, possibly over the long term, as these excerpts indicate. Food insecurity can easily create a vicious cycle, a trap from which it may be difficult for an individual to emerge from. Perhaps most compelling was the idea that food security cut to the core of survival, and not having that security in one’s life could be profoundly affecting.

“Hunger, just not knowing where they’re going to get their next meal from. That can affect you if you’re not going to have a balanced, nutritious meal. It can lead to depression, loneliness, isolation.”

“Self-esteem and confidence kind of goes down if they know that people suspect they’re experiencing food poverty, or even having to approach the food bank.”

“…emotional impact as well. And I think that’s what can slowly lead down to depression. And then, not wanting to work. It’s just a big trap they get in. Because you’ve got no food, and you’ve got kids, and you’re single by yourself. Or even if you’re just a single person you come home to nothing. You can go straight into depression, and then where does that lead you after?”

“…talking about anxiety and depression, it’s key isn’t it. And then that spiral that you get into, that’s hard to get out of.”

“And straight away I see a vicious circle really. If you’re lethargic, weak, you can’t think, you know you’re malnourished: how do you get a job? How do you keep a job? How do you change your situation really?”

“The impact of food poverty is huge, because it’s such a fundamental aspect of life and human nature, to sit and eat together with other people. And to nourish yourself, that’s what life is ultimately about, in some respects. So to not have that, to be deprived of that, I think just cuts to the core of what it means to be human. So it’s deeply affecting, I think.”

In response to Qu 5: What can be learnt from food banks and other charitable responses to hunger? What role should they play?

6. LA staff were well-versed with local charities and food aid providers. These include churches and other faith-based organisations, and community organisations that provide free meals and a place to socialise. Some frontline staff more than others saw the need for making referrals to the local food bank. The variation was linked to their specific roles within the borough, for example the kind of social work they carried out. Some staff were in roles where clients tended to approach them when other avenues had been exhausted. These staff in particular demonstrated a clear grasp of the food bank’s work (location, opening times, and facilities) and processes (the voucher referral system), and described strong working relationships with food bank staff. This direct quote is from a LA staff member, speaking of a local Trussell Trust food bank:

“I just found them very supportive, and they sometimes give you advice and support… And I think the people who run it, they’re brilliant, and they have a lot of local knowledge.”

7. The question of what role charitable organisations should play is clearly a normative one, and is fundamentally linked to the two related issues of how much need there is in society, and what the role of the state is in addressing these needs. The perceptions I uncovered in my conversations with front line staff illuminate the tensions involved in answering this question. When asked whether the balance between statutory and non-statutory support was broadly right, some LA staff suggested it was not. This was explained in terms of the charitable organisations themselves being under-resourced, and losing out on government support that had sustained them previously. One frontline worker explained that she used to draw on grants from local charities to support her clients, but that organisation itself had “folded”.

8. The same respondent grappled with the question of the role of the state and statutory support. She explained that while she agreed with the principle of instilling or restoring a sense of independence (compared to welfare dependency), the conditionality designed in to welfare reforms might have been too strong for all claimants to adjust and adapt to. Those who were unable to adapt to new welfare policies were perhaps the ones who were most vulnerable to financial crisis and food insecurity.

“On one hand I think it is right that people have got to become accountable, they can’t rely on the state. But then again I think for so long people have relied on the state to support them. And slowly that network’s been, that kind of safety net’s, been taken away. And I wonder… has it been taken away too quickly? …So many people who sat back and got their money every day, no questions asked, are now suddenly being asked to account for that money. And they don’t have the skills to do that.”

9. Charitable organisations also felt the balance between statutory and non-statutory provision was not where it should be. This was explained in two ways. The first relates to the question of the role of the state in supporting the welfare of citizens. As one food bank manager put it, when asked if the balance between statutory and non-statutory support was about right:

“No, because the charitable sector shouldn’t be providing a basic safety net… this is humanitarian work, you know, which in a country like the UK, this is not something that a charity should be dealing with. You know?! But they have to because there’s no choice, because nobody else is doing it. So the balance is totally wrong.”

10. Another way to understand this issue is from a practical perspective of capacity. Food aid providers described the challenges of raising funds and maintaining a team of volunteers. One food aid provider reported having to spend thousands of pounds on food to ensure weekly deliveries could be maintained to their client base of 300 families. The growth in the burden of non-statutory food aid provision means that charitable organisations are constantly searching for new sources of support, and rarely feel a sense of security in their own operations:

“…there [should] be more support to community groups and organisations who are providing this support. Because they’re all struggling. However long we’ve been in existence, I guarantee that [no food bank] is finding it easy to carry on a day to day basis, right? … As much as they are able to just about manage, but they couldn’t do that without the help of volunteers. And that’s great but it shouldn’t be like that.”

11. Food banks and food aid providers are innovating in order to reach more people, address the needs they witness in their communities, and make their own limited resources stretch further. Many have expanded their efforts beyond food itself, in what might be described as a ‘food aid plus’ model. Wider services included advice drop-ins to address clients’ problems with benefits, housing, debt, mental health; and efforts to promote wellbeing and health through physical activity and sports. One organisation provided emergency homeless accommodation. One offered tutoring support. Another included a community garden and kitchen that hosted community nights, entirely volunteer-run to provide a shared meal and space to socialise. The same organisation also ran a refugee resettlement programme, largely for Syrian refugees settled in Brent. The close proximity of multiple services was seen to be a good way of dealing with the multiple crises that some individuals find themselves in.

“And I think it’s interesting that lots of people here have involved advice in collaboration with the food poverty... Because lots of these situations can be resolved, or the amount of time you have to go through this traumatic experience can be shortened, lots of them can be dealt with if you can access that advice and support quickly and easily. And the food bank is an obvious place to do it.”

12. To some extent this model is found in public ‘one-stop shop’ centres, so it is not entirely new. But there is a social angle to the services provided by charitable organisations that can set them apart, if they are building social networks and social capital for individuals who may be feeling isolate and at their most lonely. Describing a food bank in north west London which had begun providing meals as well as the opportunity to pick up food to take home, one charity worker said:

“That’s a good opportunity for people to talk to each other and build relationships, and whatever. And the atmosphere in the building when you go to those places and they’re having a food bank and a meal at the same time, or a chance to sit down and eat cake and have a cup of coffee or something, the atmosphere there’s a lot better.

13. While this diverse array of initiatives is laudable, they were linked by food aid providers to the gaps left in statutory provisions as a result of spending cuts.

“Lots of these food banks hope to re-establish communities when community centres are no longer in operation, youth centres aren’t available, etc. That’s all good, but it doesn’t deal with the problem at root. And I don’t know what the solution is, because it’s so complicated. But it’s ultimately a political issue.”

In response to Qu 10: Can efforts to improve food production sustainability simultaneously offer solutions to improving food insecurity and dietary health in the UK?

14. There are opportunities to simultaneously address food poverty and food waste, and these may provide a “win-win” as one respondent described it. A number of large supermarkets were mentioned in the context of partnerships with local food banks, for example Tesco’s, Sainsbury’s, and Waitrose, often facilitated by FareShare. One food bank manager described how her collaboration with local bakeries and supermarkets meant her organisation could receive good quality food donations that could then be rapidly parcelled up and delivered as food aid to her clients. The Real Junk Food project in Burnt Oak was held up as a very positive example of how food donations from local businesses could be redistributed to local residents facing financial hardship. In these cases, the donated food would otherwise have been thrown away. The Morrisons ‘wonky range’ was mentioned as an example of how the food sector can better use all of the farmed products to make more affordable food available.

15. In the current system, food waste and food need are in many ways two sides of the same coin, and there was a feeling that the system itself was “broken”. Many of the local initiatives, which came about due to personal relationships and networks, were widely seen as a step in the right direction, but the challenge was in scaling these up and addressing systemic issues.

In response to Qu 15: Are there any additional changes at a national policy level that would help to ensure efforts to improve food insecurity and poor diet, and its impact on public health and the environment, are effectively coordinated, implemented and monitored?

16. Monitoring is essential, and a more systematic approach to collecting high quality, frequent, granular (at a local level), and comparable data would be welcome. This would allow for public health efforts to be strategic and evidence-based, as was the intention behind collecting this qualitative data in Barnet. It would further allow for robust policy analysis and evaluation that relates food insecurity trends to wider socioeconomic context and reforms. Frontline staff agreed that existing data is insufficient:

“We don’t know the actual number of people actually experiencing the food poverty. But I know, from personal experience, there are people out there just waiting for the next benefit payment to buy the good quality of food.”

“I don’t think we have the capacity to capture the actual problem and the statistics… food poverty is a hidden problem, but it exists in the community, on the streets.”

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