Sending NHS workers door-to-door to tackle sickness and benefits crisis won’t work in ‘challenging’ communities - Jayne Dowle

Supporters of the scheme are pushing for universal rollout, starting with the most deprived 10 or 20 per cent areas of the country, at a cost of around £300m.

Is this a sensible way to spend £300m? It seems like something of a gamble to me. I see the arguments in favour; it tackles the barriers to health, welfare and developing a meaningful attitude towards becoming a responsible, law-abiding, work-friendly member of society.

Workers might help residents deal with unpaid bills, missed medical check-ups and screening appointments, childcare problems, even grief and loneliness, helping to achieve solutions before problems become ‘impossible to fix’.

However, it’s important not to see this idea as a sticking plaster for all social ills. It’s reported that workers on some of these pilot projects liken their role to the return of the family doctor paying house calls. There are many bedbound and elderly people frustrated with even trying to get an appointment with their family doctor who can only dream of a house call.

Streeting must be prepared to have this panacea held to account by the cynical, who would argue that £300m could be more usefully spent elsewhere in the NHS.

The idea came from a group of GPs serving a housing estate in Pimlico, in Westminster central London, only a mile or so from the House of Commons. Here, the chasm between deprivation and wealth is extreme; according to the NHS, there’s an 18-year difference in life expectancy between those in the poorest and most affluent parts of the borough.

So in 2021, the doctors, inspired by a scheme in Brazil which supports the very poorest households, came up with the idea of creating teams of community health and wellbeing workers (CHWWs, known as ‘chewies’) in a £90,000 pilot, first funded by the local council, then taken into the NHS.

Each CHWW became responsible for checking on the health and welfare of 120 households on the estate. Their brief was to identify and help tackle the many obstacles to healthy lifestyles, dealing with everything from damp and mould in properties to debt and drug and alcohol dependency.

Such direct intervention proved so successful a series of further pilots were rolled out, including in Calderdale in our region; it’s reported that there are now more than 100 CHWWs around the country serving 20,000 households in deprived areas.

In Westminster, outcomes showed that people in households helped by CHWWs are 82 per cent more likely to attend a cancer screening, 47 per cent more likely to seek vaccination against major diseases, and 82 per cent more likely to undergo an NHS health check. Streeting believes that as well as cutting dependence on health-related benefits, CHWWs will also reduce pressure on A&Es.

Clearly, the achievements and outcomes will have been carefully measured, and it would be wrong to dismiss the CHWW model out of hand. But my fear is I can’t see it working in what we might call our more ‘challenging’ communities.

Just ask anyone employed to go door to door collecting census information or checking the number of occupants for council tax purposes. Never mind a clipboard and a stack of helpful phone numbers and practical advice; they’d say a flak jacket and a sturdy protective helmet would be more useful. I’ve heard some terrible tales of census collectors and council officials chased off with savage dogs, or ducking household objects thrown as grenades.

I have a friend who already works on a similar health and welfare scheme, supporting isolated young mothers in one of our region’s more deprived seaside towns. Over the years, she has found the job extremely challenging, and indeed, has had to take several months off work for stress herself on more than one occasion.

And there’s another caveat. How long would an assigned £300m last? Hopefully, it would go a significant way towards helping those it’s targeted at. But the big question is, then what?

Streeting must be held to account on the long-term prospects for such a scheme, otherwise all it will end up achieving is a drop in the ocean.