Naomi Watt, a respiratory nurse specialist, works on the helpline at Asthma + Lung UK. Here she talks about how price hikes are affecting the health of people calling the helpline and how she is finding ways to dig a little deeper to find out how people are coping, as the cost-of living crisis continues to bite.
New NHS England figures highlighted by Asthma + Lung UK show that living in poverty with a lung condition doubles the risk of being admitted to hospital in an emergency. A new report by the charity looks at how the cost-of-living crisis is deepening health inequalities and forcing people with lung conditions to make impossible choices about their health. A recent survey showed that the lowest earners with lung conditions are more likely than the highest earners to have seen a deterioration in their lung condition in the past year and are more likely to be struggling to manage their condition.
One case that stands out in my mind is a man in his 80s with chronic obstructive pulmonary disease (COPD), who phoned our helpline during winter when he was having a flare up. When I asked what the temperature was in his home, he told me it was 15 degrees as that’s what he could afford. I explained to him that being cold, especially when a person is older and less mobile, can be harmful and put him through to our health care advisors who advised him about benefits he could claim. But I was genuinely shocked at what he was enduring, and how profound an effect it was having on his health.
More recently, I spoke to a woman in her twenties with hay fever triggering her asthma. Even though she was earning and had a pre-payment certificate for her asthma prescriptions, she couldn’t afford her antihistamines or saline nasal spray (which her GP could not prescribe for her), putting her at risk of an asthma attack that could have been prevented.
It’s becoming increasingly impossible to ignore that there are cost of living implications at every level in society; it’s harder than ever for people to afford the medications, housing and healthy food that they need to stay well.
In just a year (from 2021 to 2022), calls to our helpline from people seeking advice on benefits, prescription charges and help paying for food and fuel increased by 70% – it can be overwhelming for healthcare professionals, when it’s not always easy to know where to point people for help.
Poverty and health inequality is all around us, and it’s not always obvious; people are proud and will often go to great lengths to hide their struggle. As healthcare professionals we need to be properly equipped to ask difficult questions in a sensitive way, to be non-judgmental, to actively listen to what patients have to say about their problems.
I tend to ask callers ‘and are you managing to keep warm in the cold weather’ or ‘lots of callers are saying to us that life’s got very expensive, are you managing ok?’, as a way of introducing financial wellbeing into the conversation. More now than ever, I also ask about air quality, especially mould and damp. Local authorities advise people to keep windows open to help with damp and mould, but how can people afford to heat a room with the window open and stay warm? For people in rented accommodation, we signpost them to resources that can help them encourage their landlord to take action. It is also a huge challenge for people who own their own homes and cannot afford to remedy issues causing damp and mould. I also ask people if they are confident that they’re getting all the benefits they are entitled to and offer them a call with our Asthma + Lung UK healthcare advisors to check.
It takes courage to ask about someone’s daily struggle, especially as it can be difficult to know where to signpost them to get the help they need, but it’s vital to tackle these issues: we can’t separate poverty and social isolation from health.
Dos and Don’ts: Cost of living conversations
Do sensitively bring the topic of financial issues into the conversation. Encourage patients to share their experiences by asking open-ended questions such as, ‘Can you tell me how your current financial situation is affecting your health?’
Do recommend that patients buy a pre-payment certificate for their prescriptions.
Do familiarise yourself with local support available, such as play schemes and food banks during the summer when children are not getting free school meals, or ‘warm banks’ for older people struggling to afford heating during the winter months.
Don’t avoid difficult subjects because you feel awkward or you’re not sure how to offer support.
Don’t assume that you can see poverty or make assumptions about a patient’s financial situation based on their outward appearance. Ask questions and encourage them to share their experiences.
Read Asthma + Lung UK’s report Breathing Unequal: examining inequalities and lung conditions. The charity is calling on the government to urgently put in place a strategy to improve respiratory care and to provide tailored financial support for people on low incomes with lung conditions, to ensure they can pay for basics like energy bills and prescriptions, helping them to manage their conditions better.
Asthma + Lung UK’s helpline team of respiratory nurses and health care advisors offer independent, confidential advice and support on lung health, and on financial issues including benefit advice. Contact them on 0300 222 5800 or by emailing [email protected].