Who uses welfare benefits advice services in primary care?

Abstract

There is considerable interest among organisations such as primary care trusts and health action zones in commissioning welfare benefits advice services in primary healthcare settings as part of local strategies to reduce health inequalities. However, very little is known about the contribution to health of such services or about the health status of those who use them. The present study reports on a longitudinal study of the contribution to individual health of welfare benefits advice in primary care that has gathered baseline demographic and health data on 345 research subjects. The average age of the subjects was 54 years, and they were likely to be unemployed or retired. Over 85% were advised to apply for welfare benefits or to appeal against the loss of a benefit, the most common benefit being Disability Living Allowance (over 50% of all subjects). Three-quarters reported a physical disability or long-term illness that limited their daily activity, and over half reported arthritis or rheumatism. Scores on the short form 36 (SF-36) which quantify self-reported physical and psychosocial aspects of health, were much lower than population norms, indicating poorer health. The burden of illness borne by users of these services is not surprising. However, reliable data has not previously been available. It appears that primary care provides good access to advice services for people in middle and old age, but not to other groups (e.g. families with young children, substance misusers or those with mental health problems). Better data collection by advice services, wherever located, would strengthen their understanding of the needs of those whom they serve, and help them to identify under-served groups. These data could be used to support requests for continued or extended funding.

Assessing the health benefits of advice services: using research evidence and logic model methods to explore complex pathways

“…Fifteen papers used validated tools to assess whether there was a measurable impact of advice services on health (Memel & Gubbay 1999, Abbott & Hobby 2000, 2002, 2003, Greasley 2003, Langley et al. 2004, Powell et al.…”

“…(2003) categorised these uses as increased spending on essentials such as food; spending to increase mobility, such as taxis; the provision of additional goods and services such as gardeners; spending on large household items such as fridges; and spending on personal items such as presents for grandchildren. Improved mobility was also reported as an outcome of some of the other non‐financial benefits such as disabled parking permits and adaptations to the house (Paris & Player 1993, Abbott & Hobby 2003, Greasley 2003, Toeg 2003, Caiels & Thurston 2005, Moffatt & Scambler 2008, Moffatt & Mackintosh 2009, Moffatt et al. 2010).…”

“…A further obstacle to demonstrating a positive impact on health relates to countervailing forces in the population, such as a steeper than average trajectory of decline for the group entitled to advice (Abbott & Hobby 2000, 2002, 2003, Turley & White 2007). Therefore, the demonstration of significant positive effects using standard baseline and outcome measures presents considerable challenges.…”

Evaluation of welfare advice in primary care: effect on practice workload and prescribing for mental health

“…We chose to examine this specifically as there was a perception among CAB staff and GPs anecdotally that the service was of particular benefit to patients with mild-to-moderate mental health issues. A number of studies have suggested that welfare advice reduces problems such as anxiety and worry and improves mental health (Abbott and Hobby, 2003;Adams et al, 2006), and may reduce overall use of health services and medicines (Abbott and Hobby, 2003). A number of studies have suggested that welfare advice reduces problems such as anxiety and worry and improves mental health (Abbott and Hobby, 2003;Adams et al, 2006), and may reduce overall use of health services and medicines (Abbott and Hobby, 2003).…”

“…The service has been advocated as contributing to reducing health inequalities and improving the health of those in poverty, through financial gain. Most studies of such services, however, suggest they are used most frequently by older people, those with disabilities and ethnic minorities, (Coppel et al, 1999;Wiggan and Talbot, 2006;Moffatt and Mackintosh, 2009) and not by those with mental health problems (Abbott and Hobby, 2003). However, there was little robust evidence that they also impact on health (Adams et al, 2006).…”