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NHS and social welfare advice: partners in a common cause
One of the key strategic approaches of the Low Commission is that the resources of the advice sector are best utilised where dedicated social welfare advisers can be placed in settings, locations or hubs that people already visit to meet other needs.
In both its first and second reports, the commission also identified considerable potential for advice to be embedded in community healthcare settings as part of the NHS’s wider offer of well-being services. In October, we staged an event at Public Health England (a key agency of the Department of Health) that brought together leading commissioners, advice providers and policy makers to explore how advice can add value to health provision. The event was hosted jointly with the Advice Services Alliance and Youth Access as part of the Department of Health’s Health and Care Strategic Partnership Programme with the voluntary and community sector to follow up on the commission’s recent report, The Role of Advice Services in Health Outcomes.
The distinguished health economist and epidemiologist Prof Michael Marmot spoke, via video link, of the importance of the healthcare system working beyond the boundaries of clinical practice to address the underlying social welfare problems causing ill health (described as ‘social determinants’), and working in partnership with the voluntary sector, especially advice providers. The evidential basis for the links between legal and health issues was then provided by Prof Pascoe Pleasence, an international authority on socio-legal data.
This was followed by a keynote address by Norman Lamb MP, covering everything that he had tried, as health minister, to break down delivery silos to enable integration of primary care, mental health services and community care and support. We also heard from Hugh Stickland, chief economist for Citizens Advice, on the socio-demographic and health data of CAB clients and their advice outcomes.
The conference then proceeded with three consecutive panel discussions:
One discussion covered ‘advice as a social prescription’, with the panel comprising advice providers including Macmillan, the Bromley by Bow Centre, Youth Access, Age UK and Sheffield Citizens Advice, which has pioneered welfare rights advice provision in an acute mental health setting. Another panel was composed of commissioning experts and agencies, including the chair of Hull CCG, Derbyshire Public Health, which funds CABx across all of Derbyshire’s GP practices, the cabinet member for social care in Southwark, and Prof Robert Poole from the Royal College of Psychiatrists. A final panel discussed the ‘systems issues’ that need to be addressed to scale up integrated welfare and health services. The panel included Lord Low, David Buck from the King’s Fund and Prof Mark Gamsu.
A range of possibilities and potential new partnerships were discussed, including embedding advice in new ‘Vanguard care models’, the potential opportunities that may be provided by devolution for integrating different local delivery pathways, the responsibilities of local authorities under the Care Act 2014, the development of social prescribing in mainstream medicine, the importance of well-being as an organising concept for commissioning and the role of health and well-being boards, the theories and practice of change management under the Simon Stevens ‘Five Year Forward View’ for the NHS, and new voluntary and community sector alliances to promote social welfare advice within the health and social care economy.
The key message from the day was that collaboration between the health and advice sectors really works and produces health dividends. For example, the data show that practical social welfare advice may, in fact, be a more effective form of intervention for mental health patients than drugs. Macmillan’s work in supporting money and welfare advice for cancer patients has also demonstrated that it can assist their recovery. But with competing pressures on the NHS, it remains a challenge to get this approach mainstreamed and scaled up. And no one model has entirely the right answer, so this agenda may not be amenable to a top-down prescriptive edict; it is more a matter of persuading NHS commissioners from the bottom up.
Everyone involved in the conference agreed to collaborate to make projects happen, and to encourage the join-up between healthcare and advice to ‘go viral’. ■
See page 4.