1768 The poverty pandemic: start seeing, screening and intervening

Background Before the COVID-19 pandemic, 4 in 10 children local to North Middlesex Hospital lived in poverty. Recent job losses, rising debt, bereavement and deteriorated mental health, all inevitably increase hardship. Poverty increases the risk of chronic diseases, mental illnesses, accidents and trauma. Surprisingly, families living in the west of Enfield and Haringey live almost 15 years longer in good health than those in the east! Objectives We challenged our paediatric staff to start seeing poverty as a chronic health problem and not just a moral issue. By screening for poverty, as we do other health risks, we can identify and intervene for vulnerable families and offer them essential help. Methods In July 2019 we explored paediatric doctors’ awareness of the social determinants of health. Using quality improvement methodology we built upon our pilot project in Kingston Hospital. Barriers to screening and possible questions were discussed. Education sessions, email communications, text reminders and leaflets were shared regularly with paediatric staff. Surveys were planned to monitor staff progress and record families being signposted. Results Barriers to screening for poverty included a perceived lack of time, inexperience, being unaware of resources and inadequate privacy during clinical assessments. In October 2019, only 10% of staff surveyed routinely screened for poverty. 13% felt they had sufficient knowledge of where to signpost families in need and 22% recalled giving social help in the preceding 3 months. To improve these rates we devised change ideas: screening questions co-designed with parents, ‘123 fight inequality’ leaflets of practical resources co-produced, presentations and workshops with local parents who had suffered hardship. Despite these and regular communications to staff, poverty screening rates worsened during the pandemic. In October 2020 we re-launched Connected Communities (CC) and the provision of support workers within the hospital. Staff reported feeling empowered knowing that practical help would be given. A poverty screening guideline was drafted with case studies and recommended screening using framing like: ‘Since the pandemic we know more parents are finding it difficult to pay bills/debts, afford food or find employment, - do you?’ Or asking ‘do you worry that your housing is affecting your child’s health?’ We delivered teaching together with CC support workers in February 2021. In March 2021, 43% of doctors and nurses surveyed reported they had screened the last patient they saw; 79% were aware of resources and; 67% had signposted someone to help in the last 3 months. From zero introductions to Connected Communities in October 2020, a staggering 95 parents have been screened and recommended to contact our support workers. Only 23 have engaged so far and they have received help with housing, finances/benefits and citizenship. Ten do not speak English but will be supported to access advice. Conclusions Tackling health inequalities takes commitment By seeing, screening and intervening, we help reduce stigma and identify vulnerable families. Our close partnership with Connected Communities increased staff confidence and increased introductions. More work is needed to determine why only 23/95 parents take up the offer but language barrier, parental expectations or clerical factors may contribute.