WIREDGOV

A recently published US study showed that one simple intervention resulted in 27% fewer visits to emergency services. This included 62% fewer visits to the emergency department for behavioural health reasons (the American term for mental health) and 87% fewer emergency department visits related to substance use.

What was this intervention – and is it something that would be easy to replicate here in England?

It was cash. Over 1,700 people in one low-income area in Massachusetts were give pre-loaded cards with up to $400 a month to spend on what they wanted for nine months. This intervention represents one of the largest controlled trials of a guaranteed income programme in the USA. The researchers linked recipients of the cash to their medical records to try and measure the impact of a minimum basic income on people’s use of health services and their health.

This study showed that cash benefits changed patterns of health care use.

Our health care system is very different from that of the US, particularly if you are on a low income. And while you can’t easily apply research findings from the US to the UK, focusing on the differences between our health care systems would be missing the point of this research. Most people spent the additional cash on food – and as such it highlights the complex relationship between financial security and health.

While the NHS is not about to give out cash to people to reduce the use of health care services, whatever the research suggests, it can and does help put money in people’s pockets by giving people benefits advice. In Liverpool, for example, 30,000 people accessed ‘advice on prescription’ over a five year period.

There is growing evidence that it is cost-effective for the NHS to provide welfare advice and thereby help maximise people’s incomes. Eagle-eyed readers of the 10 Year Health Plan will have spotted that there is now an expectation that neighbourhood health centres will offer services like debt advice. Perhaps this shows that the case for the NHS to invest in welfare advice has been made. But at a roundtable we hosted for the Money and Pensions Service last year, it was clear that financial support from the NHS for these welfare advice schemes was scarce, despite the clear benefits. The case for investment of this kind still needs to be made in many areas.

To date, evaluations of providing welfare advice have mostly looked at the return on investment in terms of extra income for individuals, rather than reducing spend for the NHS. But the focus of evaluations is starting to shift. I spoke with three people working across the voluntary sector, local authorities and the NHS who are leading the way.

Jon Pritchard, Associate Director of Population and Health Equity, Hampshire and Isle of Wight Healthcare Foundation Trust, set up a drop-in service offering social welfare advice in a mental health ward in partnership with Citizen’s Advice Winchester District. Keen to influence policy and practice, Jon says, ‘We wanted evidence that this type of support worked – for patients, for staff, and for the system. We’ve shown this service is an incredible return on investment. For every £1 we spent on the service, we avoided spending £14.06 on care costs.’ That cost avoidance largely comes from shorter lengths of stay, fewer re-admissions, reduced medication, and better engagement in available community services.

Clare Maskrey from Bolton Council, wants to see if a project to maximise people’s incomes can also reduce the pressure on the NHS. Building on the success of neighbouring council Stockport the plan is to work with GP surgeries to identify older people who might be eligible for Attendance Allowance, a benefit designed to help people over state pension age who have a disability or long-term health condition that means they need help with personal care or supervision. She adds: ‘It looks like primary care data might help us target people who are missing out on some benefits better than our council data. We want to connect people to the right financial support, but we’re also keen to understand the link between benefit take-up, visits to the GP, social inclusion and community support. Age UK are helping to evaluate the project, and we hope our findings will influence others nationally.’

Dan Hopewell, Director of Knowledge and Innovation at Bromley by Bow, has helped embed welfare advice across services in Tower Hamlets. 250 NHS staff have been trained to understand what social welfare advice is, how to identify patients and how to refer them to any one of the 23 social welfare advice providers in the borough. However, Dan highlights that one of the real challenges is the ability to bring data across the borough and suggests that we need to think earlier and more strategically about data collection if we want to convince people to invest in this area.

Convincing the NHS to invest more to tackle poverty is a challenge. It’s not always a comfortable topic for the NHS. Cost-effectiveness on the other hand is a familiar topic for the NHS and sits at the heart of many NHS decisions. Could talking about how maximising people’s incomes can lead to cost savings for the NHS create a new conversation about the role the NHS can play?

I made a deliberate decision about the title of this blog. I focused on health care cost and utilisation. Think about it and then be honest… would you have started reading if I’d called it ‘is there a quick route to tackling poverty?’