Voluntary Sector Evidence and Health Commissioning Learning from the Example of Citizens Advice

1. Webinar- 12 June 2014 #VCSJSNA Voluntary Sector Evidence and Health CommissioningLearning from the Example of Citizens Advice

2. Howard Chapman, Department of Health Howard has worked in the NHS and Department of Health for 30 years, much of that time as a Public Health and Performance Analyst. In 2008 he left the East Midlands Public Health Observatory to join the Department of Health’s Voluntary Sector Partnership Team which works to embed the value of the voluntary and community sector into mainstream policy development within DH and build stronger partnerships with the sector. Howard has particular responsibility for the Health and Care Voluntary Sector Strategic Partner Programme.

3. Background The Voluntary Sector Strategic Partner Programme. Identified need in supporting the voluntary sector use “evidence” to work with commissioners Citizens Advice is renowned for its excellent “evidence base”

4. By the end of this webinar participants will: have developed ideas for how they can use their own data to influence commissioning be aware of the CAB's Health and Poverty Tool and know how other voluntary and community sector organisations can use it have considered what evidence may be available elsewhere or that you may want to collect in order to influence health strategies

5. Jo Whaley- Regional Voices Jo is the Network Director of Regional Voices which champions the work of voluntary and community organisations to improve health, wellbeing and care across England. We are a partnership of nine regional networks. Together, we connect to over 25,000 voluntary and community organisations across England. We are a voluntary sector Strategic Partner of the Department of Health, NHS England and Public Health England. Twitter @regionalvoice

6. Growing interest in using evidence better: Relationships with commissioners + Evidence based business case _________________________ = Increased likelihood influencing commissioning

7. We’re hearing people want to know more about how you: use your own data/intelligence use open source data (what commissioners are using) work with other organisations to put a convincing case across

8. What’s the evidence? Locally tailored services for specific community needs Statutory data sets demonstrate issues Enhanced with VCS intell Proven public health interventions VCS insight on how to tailor interventions locally Data… information…insight… intelligence…

9. Resources:VCS evidence and JSNA • Background- about JSNA: Influencing Local Commissioning for Health and Care - Guidance for the VCS • Different ways VCS can influence JSNA http://www.regionalvoices.org/JSNA-more-resources • Evidence out there the VCS can use http://www.regionalvoices.org/evidence • Events/training- join your regional health and social care network http://www.regionalvoices.org/about • Briefing for health and wellbeing boards on voluntary sector evidence- coming soon (NHS Confederation)

10. Health and Poverty tools Claire Driffield, Citizens Advice

11. Claire joined Citizens Advice in July 2013. Previously Claire worked across the private and public sector focusing on improvement and efficiency projects including library services, community engagement, children’s centres, public health and environmental sustainability. Claire has a particular interest in early intervention and prevention in early years.Claire.Driffield@citizensadvice.org.uk Claire Driffield- Citizens Advice

12. Intervention pathway Successful advice Improved financial or housing stability Better health Reduced use of service

13. Health and Poverty Report • Purpose; to enable health & wellbeing boards to make the best possible use of evidence from voluntary sector advice agencies. • The problems we solve indicate needs in the community & are valid indicators • of the determinants of health • District, unitary, borough and county level • Ready written model

14. Health and Poverty Report • Integrate your local advice statistics • Child poverty • Fuel poverty • Disability • Long term health problems • Victims of domestic abuse • Environmental and neighbour • problems

15. Identifies emerging needs • Anticipate demand for advice services will continue to grow – particularly benefit, debt and housing due to; • continuing changes to benefits and tax credits that will impact severely on clients, including disabled people, people with mental health problems, and large families on low incomes. • increasing levels of poverty as these changes take effect, along with other cuts to public services and continuing high levels of unemployment • continuing high levels of debt problems with a significant increase in fuel poverty anticipated as fuel prices increase • Increasing housing problems as changes to Housing Benefit • take effect (high rent urban areas will be most affected)

16. Health Outcomes toolkit • Designed to evaluate the impact of advice services on health and poverty. • Enables advice services to conduct research amongst clients and collect evidence on: • Client profile: poverty, disabilities, long-term health problems and other forms of disadvantage • Client outcomes: changes that happen to clients after they receive advice • Mental well-being: change in levels of mental well-being among clients after they receive advice • 8 bureau tested outcomes toolkit • One stage (3 tested) • Two stage (5 tested)

17. Outcomes toolkit; results • CAB clients experienced poverty and disadvantage • Majority of clients had a disability or long-term health condition • Most also had a monthly household income of less than £800 • 2 / 3 clients experienced fuel poverty before advice • Debt situations and financial capability improved • 2 / 3 clients felt their understanding of managing their finances improved • Almost 1 / 2 clients reported an improvement in their debt situation • 1 / 3 clients achieved a tangible debt outcome e.g. debt rescheduled/ • written off • CAB services promote mental well-being • Before advice, clients had lower than average mental well-being • After help from CAB, levels of mental well-being improved • significantly

18. Mental Wellbeing • Warwick-Edinburgh Mental Well-being Scale (WEMWBS) • (Before/during) and after advice

19. WEMWBS advice intervention

20. WEMWBS advice intervention

21. Health & Poverty tools • Constructs a dialogue with health commissioners • Demonstrate your impact • Prevention • Early intervention • Speak the same language • Ongoing contribution to Health and Wellbeing agenda • Translates into commissioned services? • www.citizensadvice.org.uk/index/professionals/

22. WOLVERHAMPTON Learning from a local CAB: working with social welfare & health commissioners 2010-14

23. Jeremy Vanes- Wolverhampton Citizens Advice Jeremy has been theChief Executive at Wolverhampton Citizens Advice Bureau since 2001 and was previously the District Manager at Sandwell Citizens Advice Bureau. He also a Non Executive Director at the Royal Wolverhampton Hospitals NHS Trust Jeremy.Vanes@wcabx.org

24. From social health beginnings… • Peckham Pioneer Health centre 1936 • Midwifery, gym, immunisation, ‘Poor man’s lawyer’, CAB, snooker and a bar • Mass expansion 1939 • Bomb damage • POW parcels • The owl, Beveridge & Luftwaffe Shoebox buildings, pluck and spirit ‘Its advice work, but not as we know it’

25. ‘Its advice work, but not as we know it’ 2010-12: downturn, austerity & reform • Wolves 27th deprived LA… ? • Legal aid cuts 22% • Public sector retreat • Welfare cuts: overwhelming? • 4th highest JSA claim rate • 16k DLA claims/low skills • Child poverty doubles from 2007 • ‘Precariat’ is default new normal? Can we adapt to Localism in a downturn?

26. ‘Its advice work, but not as we know it’ 2011: new thinking before sunset CAB work doubles, so…. • Radical Efficiency • Systems thinking • Signposting Chart • Triage & call backs • Spot surveys: ‘women seek & kin nudge’ • 3rd to 67th ‘Repo in England’= early win outcome measure But food, housing crisis, depression, priority debt, lost generations are the new stealthy threats

27. “ We searched for a silver bullet, but in the end realised we needed a machine gun” ‘Its advice work, but not as we know it’ 2012-14: tipping points • Midwives & CAB fast tracks • Young ‘Fin Cap’/ social media • ‘My Financial Confidence’ tool • ‘Blended’ Debt specialism • ‘Mentoring into work’ pilot • Welfare Reform ‘point duty’ for city • SPOC Welfare Helpline 2013-14 • Volunteers & a mighty narrative

28. ‘Its advice work, but not as we know it’ So where’s the evidence? • Repo (homeless rate) = Shelter • Child Poverty = HMG ranking • Infant Mortality = DoH • Rent & Council Tax payment • JSA turnover (insecure) = DWP • Food banks (need baseline) • Looked after Children intake • True digital access rate = LA • Prescribing budgets (anxiety) = CCG Welfare Reform transforms our business too

29. ‘Its advice work, but not as we know it’ New reality beyond 2014 • 50% more demand • 40% fewer employees • ‘Same day’ handling of everything • Design ‘Triage to help Localism’ • Council Tax & Child Poverty key • But housing is the endgame • Need a credible & agile SPOC • Borderless frontline filtering • Potent volunteering added • Align incentives & teach the moments (Wasn’t Peckham set up for “advancement of education, relief of poverty… ?”)

30. ‘Welfare Advice for People who use Mental Health Services: Developing the Business Case.’ Case Study presentation by Lesley Faithful. June 2014

31. Lesley Faithful- Sheffield Citizens Advice Lesley is the Operational Manager with Sheffield Citizens Advice and Law Centre which was set up in October 2013 as a result of the merger of 13 advice services in Sheffield. Previously she was manager of Sheffield Mental Health CAB and Advocacy service.

32. Why? The need to demonstrate ‘value for money’ Who? Sheffield Mental Health CAB. (SMHCAB) Sheffield Health and Social Care Foundation Trust. (SHSCFT) Centre for Mental Health Baring foundation.

33. How? Literature Review. Analysis of SMHCAB. Quantitative analysis of the impact of welfare advice on mental health service costs.

34. LITERATURE REVIEW 83% of people with severe mental illness reported welfare rights problems. (CSJS 2007) The more ill people are, the less likely they are to seek help. (ibid.) 31% of young people with welfare rights problems also have mental health problems. Only half of all people with debt problems seek advice. (Fitch et al 2011)

35. Evidence from SMHCAB. CLIENT CHARACTERISTICS 2012/13 • 622 clients with 1,725 issues. (2.7 issues per client) • 60% related to benefits. • 48% in-patients. • 45% on income of less than £4,800p.a. • 21% homeless or living with friends/relatives. • 113 clients had their income increased by an average of £4,274 p.a.

36. COST SAVINGS Average cost of psychiatric in-patient £330 per day. Average cost of SMHCAB client £260.

37. SAVINGS PATHWAY

38. THE IMPORTANCE OF RELATIONSHIPS Trustee/CfMH Trustee/CEO CEO/SHSCT. CAB staff/SHSCT staff.

39. WHAT NEXT? All providers of secondary services should ensure that service users are given consistent access to effective welfare advice as part of their care pathway. All health and wellbeing boards should ensure that JSNA capture information about metal health and welfare rights. NHS & LA commissioners should ensure that welfare advice is included in the planning of services.

40. CONTACTS http://www.centreformentalhealth.org.uk/pdfs/Welfare_advice_MH_services.pdf lesleyfaithful@sheffieldcitizensadvice.org.uk

41. Thank you for participating! Please can you share your thoughts about today’s webinar on the evaluation form on the following link? This has been a new thing for us- help us to learn how to make the next one better! Link to evaluation form https://www.surveymonkey.com/s/webinarCAB We will circulate the link to the recorded webinar as soon as it’s available.