Healthy Advice, Healthy CommunitiesManaging health and social care resources more effectively

Our Impact on a Page

Over a third are disabled or have a long-term health condition

72% live in poverty2

Nearly 1 in 3 have a long-term health condition

22% experience a mental health problem

8 in 10clients do not reach the minimum income standard1

10% of clients are disabled, twice the national average

We make a big difference to our clients’ physical and mental health

As a result of their problem Following advice

4 in 5 felt less stressed, depressed or anxious

Nearly 1 in 2 felt their physical health had improved

Citizens Advice works directly with people experiencing fuel poverty, homelessness, domestic abuse, child poverty and disability and long-term health conditions (key Marmot indicators). We have a holistic understanding of social and economic determinants of health and wellbeing.

116,500 working and child tax credits

127,300 credit cards and unsecured loans

64,700 pay and entitlements

83,000 private rented accommodation

95,000council tax arrears

64,000 energy and utilities

Our top 6 most common problems (2015/16)

2 in 3 felt stressed, depressed or anxious

Nearly 1 in 3 felt their physical health had got worse

Our clients are disproportionately affectted by disability and health inequality. They experience low income, deprivation or poor living conditions, all of which can affect their health.

1. Joseph Rowntree Foundation’s Minimum Income Standard (MIS)2. Citizens Advice Client Poverty Profile England and Wales (2015)

How Citizens Advice delivers healthy adviceLife is complicated, and good health and wellbeing is not just a clinical issue. The practical problems matter too.

Whether it’s tackling debt problems, addressing housing issues, helping queries about benefits and employment rights, we solve practical problems that can improve health and wellbeing and reduce demand on health and social care services.

We understand the challenges health and social care care services are facing. Rising demand, budget pressure and structural change in the sector makes progress challenging.

We also know that addressing the wider determinants of health makes communities healthier and more independent, in turn saving time and money for health and social care services.

Our research shows 19% of GP time is spent on non-clinical problems costing the health service almost £400 million a year. Patient worries about employment, housing, access to welfare benefits and relationship issues are reducing the amount of treatment time for medical issues.

4 out of 5 clients told us they feel less stressed, depressed or anxious as a result of our advice intervention. Nearly 1 in 2 felt their physical health had improved.

Working with health and social care, our services can play a crucial role in recovery from severe mental illness or help to prevent long-reduce demand for services, like the Multiple Disciplinary Service in Stockton.

The breadth of our service means we have a wealth of data that offers a unique insight into the needs of local communities. Our client stories can inform the impact of service changes on the individual and how it feels to be someone trying to navigate the system. We believe that this information could be really helpful in commissioning and measuring the performance of services.

Whether it’s telling a client story, or solving a practical problem, we can improve the health and wellbeing of our communities. If you’d like more information, get in touch with us (health@citizensadvice.org.uk) to find out more.

We help 2.5 million people every year with over 6 million problems

Advice in GP surgeriesOur research shows 19% of GP time1 is spent on non-clinical problems, costing the health service almost £400 million a year.

Patient worries about employment, housing, access to welfare benefits and relationship issues reduce the amount of treatment time for medical issues.

Citizens Advice provides services in nearly 600 GP surgeries across England and Wales. Advice delivered directly in this way can reach people when most in need and resolve problems that affect physical and mental health, freeing up GP time and resources.

19%of GP time is spent on non clinical problems

1. Citizens Advice. (2015) A Very General Practice: How Much Time Do GPs Spend On Issues Other Than Health?

Better Advice, Better Lives in WalesOver the last 15 years, Citizens Advice has worked in primary care settings across Wales. In this time, we have helped 171,000 people with nearly 400,000 problems. Healthcare professionals refer patients to us who present social or financial concerns. By tackling debt problems and maximising income, we help people living in deprived areas whose health is likely to be affected by poverty.

The service benefits patients and healthcare professionals. 99% of Healthcare professionals say it’s useful to have an adviser available in the surgery and 94% say the service is beneficial to them in their work.

GP Advice Services across DerbyshireDerbyshire Public Health commission local Citizens Advice to deliver weekly advice sessions across 98 GP surgeries countywide. The service aims to tackle social and financial problems, such as job redundancy, debt, homelessness and low incomes, that can impair patient health if not addressed. The advice sessions ensure advisers are on hand to provide a seamless service to patients who raise non-health issues with their GP.

“We will only improve the public’s health if we address all of the determinants of health. The work that Citizens Advice does to resolve practical problems reduces health inequality in our region”

Julie Hirst, Public Health Manager

Reducing Demand for Long Term Care in Stockton-on-Tees Pioneering work in Stockton-on-Tees demonstrates it is possible to reduce demand on expensive long-term care through effective, holistic interventions. The Stockton Welfare Advice Network (SWAN) is based with the Multi-Disciplinary Service (MDS) team of health and care professionals that enables the holistic treatment of all the physical, social and financial needs of their clients.

Funded by the Better Care Fund, the team undertakes a single joint health and wellbeing assessment to develop a ‘care plan’ of interventions that last up to 6 weeks.

The results speak for themselves. In its first year, the team worked with over 900 people, of which only 28 people have gone onto long-term care. 517 of these clients had a welfare issue that was checked by the welfare advice worker. As a result, nearly £800,000 additional income was achieved.

Maintaining independence at homeGood quality of life is key to helping older people maintain their independence at home.

As the growing demand for social care services places unsustainable pressure on council budgets and health authorities, practical advice can play an important role in helping older people live healthy, active lives. It could be:

• An energy check that makes heating home affordable• Claiming Attendance Allowance that pays for a taxi to get out and about• Signing up for the Priority Services Register

The generalist nature of our service means we can help clients with a range of practical issues,making it easier to maintain their independence and ultimately reduce demand on social care services.

Olive is now on the priority register for energy support.

We switched Olive’s energy supplier and reduced the costs by half.

We successfully applied for warm homes discount contributing £140 towards electricity bills.

We reviewed Olive’s attendance allowance resulting in an additional £141.73 per week

Olive’s Story

Olive, 84, lives with her husband and has long-term health conditions. Following a stroke, she has poor memory and weakness down her left side. Although both have some care, they were still struggling and considering going into a care home. The MDS referred Olive to Stockton Welfare Advice Network.

Over 900 people worked with in the first year

517 clients had a welfare issue that was checked by the Citizens Advice workerr

£800,000 additional income achieved

Improving mental health in primary careMental health is the largest single cause of disability in the UK and the leading cause of sickness absence.

Mental health is the most common disability that affects people seeking our help. We see how people’s mental health problems interlink with practical problems such as money, housing, welfare and employment, and how these in turn can worsen mental health.

Citizens Advice can deliver important health improvements to clients and save time and money for mental health services.

Improving mental health in LiverpoolNHS Liverpool CCG commission South Liverpool Citizens Advice to work with 400 GPs across the city.

“If a patient is fending off the bailiffs at home, that can affect the success of mental health service intervention”, says Andy Kerr, Commissioner.

“Citizens Advice provides timely advice and support to some of the city’s most vulnerable and socially excluded people. Their intervention has a positive impact on their mental health by reducing hardship and debt. At first GPs thought it would take up too much extra time, we now know that it saves GP time and also reduces repeat appointments”.

GPs and IAPT counsellors make electronic referrals to the advice team which then works with patients to solve a range of practical problems.

“Essentially, we are now a treatment option: the GPs can prescribe an advice appointment with us as part of the treatment available to their patients”, says Caryn Matthews, Chief Executive, South Liverpool CAB.

Over the last two years the team have dealt with over 13,000 referrals, and increased income for local people by a total of £12 million.

over a fifthof our clients experience a mental health issue

“At first GPs thought it would take up too much extra time, we now know that it saves GP time and also reduces repeat appointments”

Andy Kerr, Commissioner

Supporting people with complex mental health problems

For those experiencing severe mental health problems, the practical demands of housing, employment and access to services can prove extremely difficult.

On average, a Citizens Advice client with mental health issues will have 5 separate advice problems, from unmanageable debts to employment, housing and access to welfare benefits.

Addressing these advice problems can make a real difference to people with severe mental health problems and in turn reduce the financial cost to the NHS and local authorities.

Working with Sheffield Health and Social Care FoundationThe Trust funds a dedicated Citizens Advice Mental Health team to tackle the practical problems patients have.

“We know that helping people with their financial, housing and employment problems can be crucial to their recovery and future health and wellbeing” says Kevan Taylor, Chief Executive.

Research conducted by the Centre for Mental Health concluded that this service can cut the cost of care in 3 main ways:

Reducing the length of time people stay in hospital. Resolving complex housing problems such as possible eviction or repossession can enable a patient to be discharged from hospital more quickly. The average cost of an inpatient stay is £330 per day1.

Preventing homelessness by negotiating with landlords and creditors. People with severe mental illness are at much higher risk of homelessness, the cost per person to the public sector is up to £30,000 per year.

Prevention of relapse by resolving adverse or stressful life events that often precede the onset of some severe illnesses (the vulnerability-stress model).

Jane’s story

Jane was admitted to hospital after a suicide attempt. She’d been working part-time but had accrued significant debts. Jane was due to appear in court for council tax arrears and had received an eviction notice on her private rented flat as a result of rent arrears.

Citizens Advice worked with Jane to restructure her debts, stabilise her housing and sort out the employment issues.

Resolving these problems whilst she was in hospital helped to reduce Jane’s anxiety and put her back in control of her life.

1. Centre for Mental Health, Welfare advice for people who use mental health services (2013)

Information and Advice about CareInformation and advice is fundamental to enabling people to take control of, and make well-informed choices about their care and support needs. Citizens Advice is a quality assured advice provider and often the organisation people turn to when they don’t know who else to ask for help.

We work with local voluntary and community sector partners to provide complete advice solutions and are well-placed to work across the sector to meet the information and advice needs of those help with care and support needs.

Citizens Advice NewportAcross England and Wales, there are many different models of how the legislative duty to provide information and advice is being implemented. The Newport Support Partnership is a team of highly experienced organisations who have joined together to provide care, support, advocacy and advice services across Newport on behalf of Newport City Council. Working alongside 4 local partners, Citizens Advice Newport provide information, advice and assistance to clients seeking advice on care and support needs, including benefits and entitlements.

The consortia group have developed new referral pathways between organisations to ensure that clients receive the support they need, from befriending to advocacy, advice to respite care.

David’s story

David is in his 50s and is visually impaired.

We had already helped him previously complete an application for a Personal Independent Payment (PIP) when his friend contacted us.

David was in hospital having had a stroke and and his friend didn’t understand the letters from DWP. David now needs help with daily tasks around the house as well as help getting around.

We visited David and because his health and care needs had changed significantly, we updated his PIP application. We successfully applied for the enhanced rate for mobility and the daily living rate to help fund David’s new care needs.

Working in PartnershipCitizens Advice works with the Stroke Association in Oldham to support stroke survivors.

Following their discharge from hospital, most stroke survivors want to return to their old life as soon as possible. Some of the challenges relate to non-medical issues, such as finance and benefits, as a stroke often has a profound effect on a family’s financial situation.

By working in collaboration with the Stroke Association, we can help people live as independently as possible - reducing reliance on health services and addressing long-term challenges.

Stephen Bowden, Information Advice and Support Coordinator at the Stroke Association, said: “Citizens Advice provides us with a very professional and reliable source of referral for the issues that many stroke survivors have after their stroke.

“In addition to the valuable and informed service, Citizens Advice is helpful in signposting us to an appropriate section of its services for help in a range of social issues which our service users present.

“It is a pleasure to work in collaboration with Citizens Advice and without the help it provides we would not be able to give our service users the level of help they require. Together we help stroke survivors regain their dignity and independence.”

June’s Story

Earlier this year June had a stroke, which was complicated by other muscular degeneration, arthritis and cognitive issues.

Citizens Advice successfully helped her receive Personal Independ-ence Payments and advised on how her son Philip could finish work and take on a full-time caring role.

Philip said, “This has helped me care for my mother. She feels safer and more content with me being her carer than a stranger. It has made us more independent and less reliant on others”.

“Citizens Advice provides us with a very professional and reliable source of referral for the issues that many stroke survivors have after their stroke”

Stephen Bowden, the Stroke Association

By working in collaboration with the Stroke Association, we can help people live as independently as possible - reducing reliance on health services and addressing long-term challenges.

Tackling fuel poverty and excess winter deathsIn 2015/16, there were 24,000 excess winter deaths across England and Wales, 30% of which can be directly attributed to living in a cold home.

In England, the cost of a cold home is estimated at £1.36billion to the NHS alone1. The cost to the Welsh NHS for treating cold-related hospital admissions amounts to over £100m per year2.

The National Institute of Health and Clinical Care Excellence (NICE) wants every Health and Wellbeing Board in England to commission a ‘single point of contact health and housing referral service’ to help vulnerable people who live in cold homes.

The practical solution to a cold home is to help people heat their homes more affordably.

Improving home energy standards, switching tariff or provider to a cheaper alternative and providing benefits advice can make homes more affordable to heat.

Local Citizens Advice can provide energy checks, tackle energy debts and give top tips on energy efficiency measures. We are embedded in communities and closely linked with local partners to provide effective cold homes services.

Citizens Advice ManchesterCitizens Advice have launched an innovation programme to design and test cold home referral models that will meet NICE requirements.

15% of Manchester’s total population live in fuel poverty, a total of 31,195 households. There is clearly scope to make a significant difference to living standards and healthier lives in Greater Manchester through this project.

“The Winter Resilience Programme presented a unique opportunity to co-design a new service with NHS partners,” says Kate Ashman, Project Manager at Manchester Citizens Advice.

“We are working hard to support people with COPD (Chronic Obstructive Pulmonary Disease). By partnering with the Specialist Respiratory Health Team, we deliver home visits to COPD sufferers with a wide range of problems, including damp, credit meters, arrears and applying for warm home discounts.”

“A crucial aim of our guidance was to get people working together and to simplify the process for clients. Citizens Advice Manchester are doing just that through their work with specialist respiratory nurses.”

David Sloan, NICE committee Co Chair

over 24,000 excess winter deaths in 2015/16.

1. National Institute of Health and Clinical Care Excellence (NICE) Costing statement: Excess winter deaths and illness2. National Energy Action, Fuel Poverty Statistics (2016)

Value of our data and insightOur insight can help plan health and care services and monitor performance.

The combination of our rich data and client understanding brings valuable intelligence on the needs of your community at a local or combined authority level. We are well-placed to identify services that work well and identify potential problems early on.

We can show how problems tend to cluster together and tell the real stories of what it feels like to be a user of health and care services. For example, we know a third of clients with mental health problems have advice queries about debt; of which the most common debt issue is council tax arrears.

When working-out how to eliminate waste and deliver effective and useable services for clients, it’s important to understand how existing services impact on an individual. We can tell that story in both statistics and case studies, insight that can improve local health and care services.

The depth and breadth of our data, down to Super Output Areas, can provide new service planning insights.

We can put commissioners directly in touch with service users, to provide feedback on what really matters to them.

Our local Citizens Advice services are already well-networked and work closely with other local voluntary sector partners.

Our insight can be equally useful when planning new services or monitoring the performance of existing services via a scrutiny process.

Citizens Advice Local Authority Maps: Liverpool 2015/16We can share geographical mapping for client demand cross-referenced by Indices of Multiple Deprivation down to Lower Super Output Areas for every council in England and Wales. Areas and matched against client enquiry type, here compared with the Index of Multiple Deprivation.

Citizens Advice clients (2011/12) by lower super output areaLiverpool district

Indices of multiple deprivation (2010) by lower super output areaLiverpool district

Talk to us to find out moreTo take discussions further, please contact us at:

health@citizensadvice.org.uk

© Citizens Advice February 2017Citizens Advice is an operating name of the National Association of Citizens Advice Bureaux. Registered charity number 279057

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