Suzanne Moffatt Emma Noble Institute of Health & Society Newcastle University

1. “ “It just relieves a lot of the pressure .... it takes the worry away”Evaluating the impact of welfare rights advice for people with health problems. Suzanne Moffatt Emma Noble Institute of Health & Society Newcastle University

2. Background to welfare rights and health • 1993 Citizen’s advice and general practice – BMJ • 1998 Acheson Report – tackling health inequalities BUT • Welfare rights advice services in health care often funded by ad hoc and short term sources • Need for ‘evidence base’

3. Researching the impact of welfare rights advice • Department of Health funded pilot study 2001-2005 • 126 people aged over 60 in Newcastle u Tyne • Recruited randomly via inner city General Practice • Offered domiciliary welfare rights advice Sample Mean age 71 (range 60-93) Poor health None below poverty line, but most low income

4. Outcome of welfare rights advice for people aged over 60

5. Evaluating impact • 2 methods • Quantitative study • Wide range of physical, mental health outcome measures • Qualitative study • Interviews with 25 people plus 10 carers at baseline and follow-up (18 months)

6. Impact of welfare rights advice for people aged over 60: findings from interviews Welfare Rights Advice Financial benefit Non-financial benefits Necessities Occasional expenses Capacity to cope with crises Peace of mind Ability to participate in society Maintaining independence

7. Evaluation of WRA service for people with cancer and their carers • June 2008, Durham County Council and Macmillan Cancer Support • 3 dedicated welfare rights advisers • Advice in a range of settings • Interim findings, service and evaluation on-going

8. Background to Service • 1/3 live in the most deprived areas of England, 10% live in the least deprived areas • Life expectancy/early deaths from cancer worse than the average for England • Poor access to welfare benefits: Macmillan Cancer Support

9. Methods to Evaluate Service Interview Study: • 44 clients and carers from January 2009 - present • 15 followed up by July 2010 • Topic guide Statistical Study: • Descriptive analysis of 2 yrs of quantitative data

10. Sample Attributes

11. Employment Status

12. Individual Circumstances • Short/long term interruptions work • Occupational sickness pay v SSP • ESA/IB: ability to work again • Over SPA: already reduced income • Carers • For some, cancer did not affect their financial situation

13. Impact of Receiving Benefits Specific Impact • Loss of earnings or unemployment • Travel/parking costs • Heating bills • Dietary needs • Clothing needs Overall Impact • Reduced stress & anxiety • Increased security

14. “It takes the pressure off.....you know it takes the worry away. You can concentrate on getting yourself better or making your life as comfortable as you can...it’s one less thing to worry about … It gets one of your main concerns covered if you like.....I think the worry would have killed us off, not the cancer” (female, aged 65 )

15. Characteristics of Service • Individuals were advised about benefit entitlement • Practical assistance with completing forms • No longer had to cope alone with complex benefits system • Expert advice, timed to suit individuals

16. Conclusions • Welfare rights services should be available as a multi-disciplinary approach for everyone with cancer. • A dedicated service allows health care professionals to refer individuals for expert advice whenever it is needed. • Without this service, many people affected by cancer will miss out on benefit entitlements at a time when they need it most.

17. Dissemination • Final report available early 2011 • Interim findings: open access on-line journal should be available in 2-3 months • Findings widely disseminated after completion of study in 2011 • Contact: S.M.moffatt@ncl.ac.uk e.j.noble@ncl.ac.uk