Health&benefits wolvs290612

14
Citizens Advice in GP Surgeries: process and outcomes in Derbyshire Julie Hirst Public Health Specialist NHS Derbyshire County Benefits and Health Event, Wolverhampton Friday 29 th June 2012

Transcript of Health&benefits wolvs290612

Page 1: Health&benefits wolvs290612

Citizens Advice in GP Surgeries:process and outcomes in Derbyshire

Julie Hirst Public Health SpecialistNHS Derbyshire County

Benefits and Health Event, Wolverhampton Friday 29th June 2012

Page 2: Health&benefits wolvs290612

Derbyshire

Page 3: Health&benefits wolvs290612

Derbyshire County Profile

• Population of 750,000• Mainly rural county with diverse

communities, e.g. • Ex-coalfield communities in Bolsover &

North East• Chesterfield: largest town of 100,000• Large part of Peak District National Park• Tourist destinations of Bakewell and Buxton

Page 4: Health&benefits wolvs290612

Political landscape

• Two tier local government system• County Council turned Conservative in 2009,

following 28 years’ of Labour control• Mixed political landscape at district and borough

level• Public Health directorate will sit in the Policy

directorate of DCC

• DPH will be managed by strategic director

Page 5: Health&benefits wolvs290612

Health Profile

• Pretty much average for England• Life expectancy similar to England but 7.6 years lower

for men and 5.4 years lower for women in the most deprived areas of Derbyshire than in the least deprived areas

• Estimated levels of adult obesity are worse than the England average. Rates of road injuries and deaths and hospital stays for alcohol related harm are higher than average

Page 6: Health&benefits wolvs290612

Citizens Advice in GP Surgeries

• Paris & Player paper BMJ 1993• Piloted in Hayfield in 1995• CAB in all 16 surgeries of High Peak and Dales PCT

(pop = 106,000) by 2004• Derbyshire County PCT emerged in 2006 – project

saved from extinction by DPH• CH funding to roll out between 2008-10

• Since 2010/11 CAB in 90/96 GP surgeries

Page 7: Health&benefits wolvs290612

Delivery

• Commission standardised weekly service from 5 local Citizens Advice Bureaux

• Paid advisors work from surgery using lap top and mobile phone

• Surgeries make appointments

• Open referral system

• Paid quarterly in advance

• Annual reports

Page 8: Health&benefits wolvs290612

Outputs 2011/12

• Clients seen 5,957• Contacts 17,138• Enquiries 29,673• Financial gains £7,698,310• Debt managed £8,138,401• Cost per client £131• Cost per contact £45• Cost per enquiry £26

Page 9: Health&benefits wolvs290612

Costs and Gains

•Cost to commissioners = £767,377

•Every £1 invested generates £11 for clients and the same £1 helps them to manage £10.60 of their debt.

Page 10: Health&benefits wolvs290612

Impact on lives

• Collection of case studies which illustrate the complexity and enormity of clients’ problems, the skilled and detailed work that CAB provides and its impact on clients’ lives.

• Almost certainly saves money ‘downstream’• But does it improve health????

Page 11: Health&benefits wolvs290612

‘Welfare advice in primary care: A qualitative study of service user and staff perceptions’ (Burrows et al 2011 BJGP)

• Popular with patients and staff• Anonymity of healthcare setting valued• Accessible: geographically and physically• Appointments system preferred• Continuity of CAB staff valued by patients• Valued resource for health staff to refer to• Saves GP time• Variation of CAB integration into practice

Page 12: Health&benefits wolvs290612

‘Assessing the health benefits of advice services: using systematic review and logic model methods to explore complex pathways’ (Allmark et al, in press)

• A plausible case for CAB advice to improve health based on a causal chain can be made.

• However, it very difficult to show direct cause and effect

between Citizens Advice and improved health. The determinants of health are so complex and the benefits accrued from a CAB referral are likely to be limited and/or highly variable in the context of all the other influences on people’s health and lives.   

Page 13: Health&benefits wolvs290612

Logic model method

Page 14: Health&benefits wolvs290612

Thank you.