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
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.
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.
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