Evidence shows money spent on legal services means savings to the NHS; lawyers and medics must work together
A growing body of evidence indicates a link between ill health and the lack of availability of advice to assist people with their legal problems. LAG argues that we have to persuade policy-makers to adopt an integrated strategy for advice and health services, rather than allowing the current piecemeal approach to continue.
This is not a new idea.
It was in Birmingham in the early 1990s that Citizens Advice Bureaux pioneered the provision of advice services in GPs’ surgeries. That model was enthusiastically adopted in Derbyshire, where the number of surgeries covered by the scheme has grown from one, in 1995, to 98 out of the 102 practices in the county.
Originally, the Derbyshire CAB Healthy Advice project was funded by the local county council. The Health and Social Care Act 2012 transferred many public health functions to local councils. This led to the inclusion of the Healthy Advice service in the public health functions that Derbyshire and other councils took over from the NHS.
Derbyshire CAB argues that the factors influencing health go beyond the medical issues that GPs deal with and include coping with social welfare law problems, such as entitlement to welfare benefits and debts. Derbyshire, in its geographical coverage, has one of the most comprehensive integrated health and advice services in the country. There are other places with such services, Liverpool, for example, but they are in the minority.
This month, the Low Commission into the future of legal advice and support, which was set up by LAG, is holding a seminar jointly with the Advice Services Alliance and other partners. The aim is to bring together advice practitioners with health commissioners. Like other public services, the NHS is facing budget restraints, but it is to be hoped that by sharing experiences from places like Liverpool and Derbyshire, the argument that investing in such services results in savings in health budgets can gain more widespread acceptance.
While the social determinants of health may be supported by strong evidence, it is not necessarily a theory that will play well politically with the present government.
One of the main barriers to an increase in advice services run in conjunction with the NHS is the issue of who pays for them. Clinical commissioning groups, which procure hospital, GP and other services in the NHS, tend to be dominated by clinicians who see their task as buying direct healthcare as opposed to services that have the wider health benefit of reducing demand.
Prof Michael Marmot’s research on health inequalities demonstrates how people’s health may be determined by social issues. Marmot, who will be speaking at the Low Commission event, headed a review of health inequalities in England that resulted in the report Fair Society, Healthy Lives, published in 2010. It concludes that ‘health inequalities result from social equalities’ and calls for action on six policy objectives, including creating ‘fair employment and good work for all’, and giving ‘every child the best start in life’.
The research on health inequalities and the transfer of public health duties to local authorities could play an important part in changing the thinking around the types of services that can lead to better health outcomes. The proviso to this is that budget pressures do not get too acute. There is a danger that budgets for local government-provided health services will be reduced in preference to the clinical services in the NHS, which carry a bigger political risk if they are cut.
LAG believes health and legal advice projects should not be seen as the exclusive preserve of the not-for-profit sector. Solicitors’ firms and other legal professionals in the private sector can bring much experience and expertise to the field. They need to be wary, though, as does the Nfp sector, of the potential for conflicts of interests with public authorities, often looking to cut costs at the expense of individual rights.
While the social determinants of health might be well supported by a strong evidence base, it is not necessarily a theory that will play well politically with the present government. ‘Social determinants’ might sound too much like socialism to some ministers’ ears. The argument that investing in legal advice services saves health resources needs to be emphasised. It also has to be backed up with the statistics and other research, as we are living in times in which such a pragmatic approach, as opposed to idealism, is more likely to persuade policy-makers to invest in legal advice. ■
Legal aid cuts are making clients sick, page 10.