“Just what the doctor ordered”Research into health-based welfare rights advice for Age Concern England Neil Batemanwww.neilbateman.co.uk
The project • Research commissioned by Age Concern England to identify scale, funding, monitoring, range and impact of independent benefits advice delivered in healthcare settings in England • Also to look at lessons; what works/doesn’t work & what’s needed.
Research methods • Project team: Neil Bateman and Geoff Fimister reporting to Sally West at ACE • Survey, data collection from national bodies, mapping of provision • Literature survey on impact of WR advice on health • Telephone interviews with 5 very different projects and up to three stakeholders per project • Additional two projects (Liverpool HABIT and Southwark WRS) visited and written up as case studies
Findings • 170 services, variety of providers and advice methods (mostly CAB or LA WR services). Incl at least 10.5% (889) of GPs’ practices. 167 fte paid advisers. 523 are CAB services • 33% decline in these CAB services from 2005 • Distribution of services very variable • 74 hospitals, 93 MH settings, 27 other NHS • 6,179 hrs (167 fte advisers)
Findings (2) • £5.77m spent on services, • £43 - £58 m extra in benefits, for estimated 28,216 people in 2006 (£1,549 per service user). 70+% aged over 65? • £260,523 per fte adviser = return of £10.13 per £1 spent on service • Everyone reports a positive impact on health/well being, especially a drop in stress • More research needed to quantify impact, but like many clinical interventions, it may be hard to quantify the health impact
Key messages • PCTs often marginal. Can run without them, but need PCT backing for service to be sustainable and integrated • Most services financially weak (eg big decline in CAB services) • Performance measurement too variable. Monitoring is variable • Use pre-booked appointments, but be flexible • The right type of adviser is important • Lack of a national strategy, confusion about role of DWP & welfare reform • Relationships with NHS counterparts are vital • Services highly valued by stakeholders • Paradox of sustainability: overload
How not to set up an advice service in the NHS • Insufficient evidence of need & impact • Initiative parachuting • Lack of a champion • Insufficient time spent building relationships • Unclear referral process/criteria • Ignoring the PCT and/or NHS trust • Inconsistent use of advisers • Rigid service model • Extravagant needs for premises • Poor grasp of health care professionals’ needs • Poor rationale for the method used • No long-term funding possible.