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What have acute hospitals to do with prevention and the social determinants?

July 12, 2019

I was in an Integrated Care System meeting recently and was (sadly) not surprised to be told by an Acute Hospital Chief Executive that they did not have a role to play in the prevention agenda – this rested with agencies outside hospital such as primary care, public health, local government etc.

In response I told the story of a small piece of work Citizens Advice Sheffield has been doing with the Sheffield Teaching Hospital Trust. We have been providing a targeted ward based welfare benefits advice service for the last 6 months which is specifically aimed at people who are using the major trauma unit.

These are people who are recovering from traumatic injury that may have arisen from a fall, a serious assault or road traffic accident.

As you can imagine in addition to the physical impact of trauma people have to deal with the effect this has on other parts of their lives such as their ability to work and sustain employment.

Further, they have to work their way through the benefit system – making the case for benefits they are entitled to that can include Personal Independence Payments, Carers and Attendance Allowance.

All the time they are coming to terms with their new status they run the risk of personal indebtedness as they try to stabilise their finances. For example according to MacMillan people who are diagnosed with Cancer on face an average drop of £570 in monthly income for similar reasons.

It should be clear that trying to address these issues at such a difficult time can have a negative effect on wellbeing and personal resilience which in turn can effect peoples ability to engage with and respond to treatment.

As can be seen in the table below the bulk of this pilots work focussed on benefits and tax credits, with the next largest area being employment.


 

When we look at the benefit issues some of the major areas are:

  • Personal Independence Payments
  • Help with an initial claim – I would imagine that for many people this may be their first encounter with the benefit system
  • Employment Support Allowance
  • Council Tax Reduction

 

Cost

The full cost of this service over a year is £7,000. At the moment the service is funded as a pilot by the Sheffield Teaching Hospitals Charity, but the ambition is that this will eventually receive mainstream funding.

Going Forward

The lessons provided by this service are clear. It builds on work that Citizens Advice Sheffield already does with regard to Mental Health and Cancer (of course Macmillan have pioneered welfare rights and cancer for years) where welfare rights services are aligned with and integrated into communityheath trust and acute hospital assessment and care pathways. There are plenty of other areas where there could be similar benefits – such as Stroke with degenerative illnesses like Parkinsons and Multiple Sclerosis.

The key issue is recognising that some illnesses and conditions cause a significant impact on people’s ability to control their own wellbeing and access to welfare rights and financial support has to be targeted and built into the health pathway.

Acute Hospitals

So, going back to the start of this blog – acute hospitals do have a significant role to play in prevention – and part of this is about changing the way they provide services IN hospital. As Dr Kevin Smith (Head of Healthcare at Public Health England) said at the time – we should not be led by ‘bean counting’ performance targets – the issue is how we ensure that when people are in our care we address the health and wellbeing needs of the whole person – this means addressing the social determinants of health is the responsibility of all parts of the NHS.

What do you think?

Declaration of interest – I am the chair of Citizens Advice Sheffield

8 Comments leave one →
  1. robdalziel permalink
    July 12, 2019 23:15

    Yes, I was disappointed when a proposal to have Navgators, which was part of the service specification for a new urgent care centre at the Russells Hall Hospital in Dudley was in the end dropped.
    The Navigators were to have been there to pick up referrals from clinicians where it was felt they coul benefit from help and advice with benefits, housing matters and getting access to different services provided by public and voluntary sector organisations. It is recognised that a significant number of people turning up at hospital had various other things going on in their lives that ultimately affected their quality of life and health in adverse ways

    • July 14, 2019 19:48

      Good to hear from you Rob. It continues to be a battle – arguing the case for a holistic approach to wellbeing – I do think that while in hospital it is the primary responsible of the hospital to coordinate care that works best on the ward – and in some cases this has to include resolving key issues such as housing and finance before people leave.

  2. malcolmrigler permalink
    July 13, 2019 08:45

    Interesting that “Health Navigators” were dropped in Dudley – I wonder why? Maybe it will be better for such “Health Navigators” to be based in the developing High Street Learning Centres / Digital Health Hubs that are now beginning to be set up around the UK. The Society of Local Council Clerks ( Town and Parish 5,000 Clerks in Membership) is supporting this new development and Prof Kim Cassidy at Edge Hill University near Liverpool is soon to hold a workshop/showcase for this initiative as part of rescuing The High Street from decline by diversifying the “High Street Offer” into “Health” , “Education” and “Community Development” . From such High Street venues strong links with all NHS facilities such as A and E and Urgent Care Units could be established so that Nurses on duty can signpost patients and carers to the help with obtaining the financial benefits to which they need and to which they will be entitled.
    See:
    Find out more about Nailsea Place and 65 High Street | nailseatown.com
    https://www.nailseatown.com/find-out-more-about-nailsea-place-and-65-high-street/
    11 Feb 2019 – The video below, commissioned by Nailsea Town Council, promotes 65 High Street and the wider Nailsea Place project. Watch it here: …

    • July 14, 2019 19:50

      Thanks Malcolm I will check out the video. The bit for me is that I think on occasion there are some issues that just have to be resolved while someone is in hospital – particularly if this means ensuring that someone is able to return to an environment that facilitates there recovery. I think the challenge for us is being able to articulate clearly when community based intervention is most appropriate and when it is better to do so while a patient is still in hospital – all the best Mark

  3. July 13, 2019 13:48

    Thank you for this story, Mark. All we seem to hear about these days is having to do more (services) with less (funding). However, examples like this demonstrate that by re-thinking and changing mindsets, joined up working actually means that it is possible to do more (services) with more (joined up resources). Creative thinking and innovation often come from being backed into a corner when we have to look for different options.

    • July 14, 2019 19:51

      Lovely to hear from you Julia – I agree – there is a lot of rhetoric about culture change but the challenge is actually making it happen.

  4. Charles Heatley permalink
    July 13, 2019 20:35

    Mark, we are working on it. When we set up the CASES system in Sheffield for GP peer review we met with 8 clinical specialties and invited the specialists to become clinical champions for the health of the people of Sheffield with the areas they work in. Now through the Accountable Care Partnership we will bring prevention back onto the agenda.

    • July 14, 2019 19:51

      Hey Charles – we need a little chat! I will chase you next week! Best Mark

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