“Just what the doctor ordered” Research into health-based welfare rights advice for Age Concern England Neil Bateman

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.