Description of the programme
Tenovus Cancer Care (TCC) ‘supports and enables’ cancer patients in Wales. The Tenovus Cancer Care Money Advice Service (TMAS) aims to embed financial capability for people with cancer who are on a low income or in financial difficulty, at an early stage in their diagnosis. TMAS is structured around delivering three one hour one-to-one sessions with clients. The focus of the planned sessions was derived from the Money Advice Service Adult Outcomes Framework and sought to address skills and knowledge, attitudes towards money, motivation to take action, and access to financial services..
The interventions are tailored to the client’s needs, and may include:
- Establishing a client’s numeracy skills;
- Examining basic money management skills, such as budgeting, income maximisation, and understanding of priority and non-priority debts;
- Giving basic debt advice, and taking required action (for example, referring clients to specialist debt advisors);
- Providing information about, and signposting/referrals to, appropriate financial products and services, such as those provided by Credit Unions.
The overall research question was: For people who have received a cancer diagnosis within the last six months and are in financial difficulty (or on a low income), can access to financial capability advice, training and support mitigate the financial impact of their cancer diagnosis?
The aim of the evaluation was to review the TMAS processes around adoption and implementation of their intervention and to capture the wider experiences and impressions of clients and providers, relating to engagement and delivery.
The evaluation questions developed were:
- What are the demographic characteristics of the clients served by TMAS?
- To what extent does TMAS meet client needs?
- What are the referral agents’ experiences and impressions of TMAS?
- What are the experiences and impressions of the programme delivery by TMAS/TCC staff?
- What type of activities take place?
- To what extent are the activities delivered as intended?
- What resources and plans are in place to ensure TMAS sustainability?
The evaluation comprised of:
- 26 questionnaires;
- only four post-intervention questionnaires, due to many of the client group being terminally ill;
- Ten participants interviews;
- 11 stakeholder interviews (including Tenovus and NHS staff).
Due to the extremely limited findings from the survey, it is difficult to provide significant quantitative results. However, the interviews showed:
- External stakeholders saw debt advice as a meaningful and necessary service for the group of clients targeted.
- Referral agents were not always aware of how debt advice was situated relative to other financial advice such as benefits advice.
- Internal stakeholders felt TMAS had made a positive difference to clients.
- The fact that the demands on the service were exceeding the initial resources made available was recognised.
- The inclusive nature of TCC as an organisation meant that on occasion TMAS was not being delivered as a unique debt advice intervention.
- TCC and TMAS advisors had multiple skillsets which they drew on in their roles, resulting in the boundaries relating to the TMAS inclusion criteria often being extended.
- Resultantly, there appears to have been flexibility in regard to those who were able to access the service as well as the exact nature of the service delivered.
- The client outcomes appear positive in regard to addressing debt issues; however, due to the nature of the client group (i.e., many are dealing with terminal cancer), the planned activities do not appear to have been delivered regarding increasing capacity for improved financial management.
- In addition to practical impacts from accessing the service, clients reported psychological and mental wellbeing benefits.
- At the time of the evaluation interviews there was uncertainty about continued project funding and therefore concerns about the sustainability of the service were noted.
Points to consider
Methodological limitations: Tenovus struggled to engage clients for interviews, with service users being too ill to follow up, or in some cases having passed away. Unfortunately, this meant that insufficient numbers of questionnaires were completed to draw statistically significant inferences. Individual case studies can be drawn out to give examples of change, though the sample size was too small to be confident that the cause of the change was due to the services provided.
Relevance: This report is relevant to all stakeholders and policymakers with an interest in financial capability interventions among patients suffering from serious, chronic and in some cases terminal, illness.
Generalisability/ transferability: The research, while thorough, is based on small numbers in one geographic region of the United Kingdom. Combined with the lack of statistical testing, its findings cannot be readily generalised to the rest of the UK without further research. However, the sensitive nature of this intervention means the findings may have useful indications of ‘what works’ for similar schemes elsewhere.
Evaluation of the Tenovus Money Advice Service (ETMAS) - full report