Developing advice in health care settings

Lucy Cochrane of Citizens Advice outlines a pilot project developed in partnership with health and social care workers, which addresses the links between poverty and ill health in the Northern Health and Social Services Board area.

Advice 4 Health is a new one year pilot project developed by Citizens Advice and health and social care professionals and funded by the Northern Investing for Health Partnership. Its aim is to provide a range of advice and advocacy services to the public in a range of health settings in the Northern Health and Social Services Board region. The project is the result of a partnership between seven Citizens Advice Bureaux, three Health Trusts, four local Health and Social Care groups, the Northern Neighbourhoods Health Action Zone and the Northern Investing for Health Partnership.

Over recent years, Citizens Advice has continued to develop its services in healthcare environments. As well as securing health benefits, services in healthcare settings are an excellent way of bringing advice to those who are perhaps most in need of it, as people who are sick, disabled or elderly often find it difficult to reach bureaux.

Health and social care professionals recognise that poverty can be the cause of many illnesses - for example this can often lead to patients developing conditions of stress, anxiety and depression - and that it can be the reason they cannot follow medical advice to turn up their heating or modify their diet. It is impractical to suggest that doctors and other medical staff should become experts in welfare benefits, housing rights or debt counselling, but by working together health and social care professionals and CABx can develop strategies to address these problems.

Partnership schemes between CABx and health practitioners give them the additional resource of skilled, experienced CAB advisers on hand to tackle some of the social and economic problems directly associated with ill health. Patients get on the spot advice and assistance with benefits claims, employment rights, housing problems such as damp and overcrowding, debt management, and family and personal problems. CAB experience and expertise in these areas extends to advocacy and representation, for instance at social security tribunals.

CABx tackle poverty and ill health in a range of ways. Advisers have considerable expertise and experience in maximising clients’ income, and often find that people are not claiming benefits to which they are entitled. They also help people to tackle their poor housing, to get adaptations for their homes and to access community care services.

Frequently, we see complex cases which contain multiple issues. An accident at work may trigger debts, a claim for benefits, a medical appeal tribunal, and impact upon family relationships. We are able to offer people a holistic advice service and to mediate and advocate on their behalf. This includes an outreach service in people’s homes underpinned by the use of laptop computers, and a housebound person with disabilities may require help with a claim for benefits, advocacy at a tribunal, an application for help with adaptations to the home involving liaison with NIHE, an occupational therapist and a private landlord for example

Poverty is recognised as a major contributor to poor health and well-being within the local population in Northern Ireland. A recent report Bare Necessities – Poverty and Social Exclusion in N. Ireland revealed that there are 185,000 households living in poverty. Within the Northern Investing for Health Partnership area, 33 wards are ranked in the 35% most deprived as identified by the Noble Measures of Deprivation.

In partnership with colleagues from the health and social care sector, Advice 4 Health has been developed to reduce poverty and tackle disadvantage in the Northern Investing for Health Partnership area. This initiative aims to increase benefit take-up. In the course of their work, many health and social care staff encounter patients and clients in poverty and through the delivery of this project will act as a referral point to the project.

The aims of the project are to:

• assist the health care sector improve the health of and address health inequalities and reduce poverty in the community by increasing the public’s access to a range of information and advice services;
• maximise benefit take-up in the community with a particular focus on the elderly, people with disabilities, people with mental health difficulties and families living in poverty;
• reduce poverty and tackle health inequalities in the Northern Health and Social Services Board area by exploring a range of models by which these services can be delivered for example, by referral from community care teams, in hospitals, in GP’s surgeries and in housing estates in specified geographical areas in the Northern Neighbourhoods Health Action Zone.

Four CAB appointed advice and advocacy workers will operate from local CAB offices in Newtownabbey, Larne and Carrickfergus, Antrim and Ballymena, Coleraine, Ballymoney and Moyle, and Cookstown and Magherafelt, as part of a partnership arrangement with health and social care professionals to deliver advice and advocacy services to the public. They will establish effective systems to enable those who are experiencing hardship to access the full range of support available. It is anticipated that these four advisers working across a range of health settings including hospitals and GP surgeries will deal with up to 10,000 enquiries over the year of the project, resulting in approximately £400,000 of additional benefit being accessed by families living in poverty, older people, people with disabilities and people with mental health difficulties. For more information about the project which began in April please contact Dave Murphy at Citizens Advice Regional Office.