Here, James Sandbach, Research Manager for the Low Commission reflects on the impact advice services can have on our wellbeing and health.
The VCSE (Voluntary, Community, Social Enterprise) review on partnerships for health and wellbeing has been the latest in a number of strategic studies looking at how bringing in a wider range of community based services into the health system can contribute to improving health, wellbeing and care outcomes.
The recent Kings Fund report on “Supporting integration through new roles and working across boundaries” is also an important piece of work highlighting some of the issues about the interface between non-clinical support workers and health professionals within the health system. As new care models emerge outlining different strategies to provide the right services by the right teams at the right time targeting individual needs and delivering place-based population health systems, searching questions are being asked about what sort of partners should commissioners and provider bodies be working with to deliver social value and reduce health inequalities.
An important sector that tends to get overlooked in this debate is the contribution of the advice sector, ie organisations providing free welfare, money/debt and legal advice, information and assistance. Evidence for example of the value of placing a local Citizens Advice service outreach within GP surgeries has long been amassing for several decades.[1] However it is only in the past couple of years, especially as ideas around social prescribing have taken root, that there has been any discernable interest in looking more systematically about how advice services can add value or support improved health and wellbeing outcomes in health settings and contexts. Last year the Low Commission
– an independent Commission on the future of the advice sector – undertook an extensive evidence review on the relationship between advice and health outcomes, and models of good practice in collaboration and service delivery. It found that:
“The effects of welfare advice on patient health are significant and include: lower stress and anxiety, better sleeping patterns, more effective use of medication, smoking cessation, and improved diet and physical activity.”
The review looked at provision of welfare advice provision in primary health settings, mental health services and also in secondary and tertiary care settings for example in supporting the discharge planning process and rehabilitation. Evidence of the value of advice based interventions were particularly strong in the mental health context, perhaps unsurprisingly given the amount of empirical data collected in recent years focussing on the relationship between indebtedness and poor mental health, and also in areas like homelessness prevention, income maximisation, community support and reduced in-stays and repeat appointments. Of course as you might expect the evidence base is somewhat varied, with much of it in the “grey literature” territory, but also some more robust data emerging from advice services capturing specifically capturing health outcomes generally gathered from before and after follow up assessments with clients, most commonly using the Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS).
Critically from a policy perspective the research found considerable variation across commissioners in their approach to engaging the advice sector or requirements when commissioning services; at one end of the spectrum there are examples of commissioning partners making considerable investments in advice services to address deprivation and health inequalities and at the other end of the spectrum advice service providers are struggling to engage key commissioners, and services are being decommissioned due to financial pressures. I’ll leave it to readers to study the report and decide for themselves about whether welfare advice in health settings is a good example of “what works in wellbeing,” but it is worth repeating Michael Marmot’s clarion call from the report’s foreword “to broaden our thinking in the future if we are really to put patients and their whole experience and needs at the heart of everything we do.”
James Sandbach was Research Manager for the Low Commission which ran from 2013-2016
[1] Veitch T. & Terry A. (1993) Citizens’ advice in general practice. Patients benefit from advice. British Medical Journal 307, 262.
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