Description of the programme
Between January 2017 and March 2018 Auriga Services was funded by the Money Advice Service (MAS) under the ‘What Works Fund’ to develop the financial capability of patients with renal failure and people with inherited metabolic disorders (IMD). The project was delivered through face-to-face advice and support in healthcare settings in Birmingham and the West Midlands. The project worked with 409 renal and 73 IMD patients between January 2017 and January 2018.
Project interventions initially focussed on delivering welfare advice and benefit maximisation to patients on a one-to-one basis. The funding from the ‘What Works Fund’ enabled the service to be expanded into the provision of information and guidance to help patients understand and extend their financial capability. To support the advice work, a set of fact sheets was produced and distributed to help participants understand financial capability concepts and to give practical advice on managing budgets, utility tariffs, online banking and other financial products and processes.
The main research question posed was:
- To what extent do interventions in a healthcare setting improve patient engagement with financial capability?
To answer this, the project reviewed the outcomes of welfare benefit interventions and financial capability amongst participants. The relationship between the interventions and change in physical and mental wellbeing was also then reviewed.
The evaluation included:
- A baseline and follow up survey (152 baseline and 78 follow-up surveys;
- A control group who received no direct intervention;
- 28 qualitative interviews and observations with medical staff, patients and project staff to review project process and outcomes;
- Eight patient case studies.
- Managing well day to day
- Maximising Income
- Managing debt
- Increased financial confidence
- Interventions delivered by the project to those outside the control group supported patients to maximise their income from welfare benefits, economising on bills and minimising expenditure, gaining access to the most economical tariffs, accessing in-kind benefits, and where appropriate, rescheduling payment plans.
- The project team realised substantial additional income to individual patients totalling c. £581,000 from sources including welfare benefits, grants and savings on utility tariffs. Several patients reported being able to return to their former methods of setting clear weekly or monthly household budgets, including setting aside savings in some cases, after their household income had been re-established, as well as managing repayments for arrears more effectively.
- The surveys showed small increases in shopping around for the best deals, willingness to talk to family and friends about money, keeping track of spending and budgeting.
- Following the intervention there was also a small increase in the number of participants who felt they could access the internet for advice, as well as an increase in the number of participants who would prefer to speak to a specialist advisor to deal with money problems.
- Patients described a variety of positive changes that came about with their increased income including: being able to make improvements to their diet; heat their houses without worry; and keep themselves and their houses cleaner with less concern about water bills.
- The financial capability of patients was strongly linked to their previous experience of managing their household budget. Where their income was increased they had more confidence and capability, as well as the resources to make financial decisions and plans.
- Conversely, patients who suffered an income shock, and additionally had no experience of household budgeting, were at a very high risk of falling into financial crisis and were vulnerable to abuse. These patients reported their financial situations being stabilised through the project, reductions in stress and an overall increase in confidence about the future.
- Patients were able to draw on an advice service within a trusted and familiar environment. Healthcare staff emphasised the importance of having a service coterminous with other health interventions.
- Interviewees indicated that they preferred to receive support from a trusted adviser, on a one-to-one basis, and that this was more effective than the provision of written information via the fact sheets.
- Interventions with IMD patients needed extra time to establish than those with renal units, due to Auriga already having a presence within renal units, and because of the different demographic of patients and logistics of clinic based delivery.
Points to consider
Methodological strengths and limitations:
- The lack of change in the control group suggests that the outcomes measured are due to changes brought about by the intervention.
- The findings are mainly from the qualitative evidence, and where the quantitative findings are reported they are based on low sample sizes (acknowledged by authors). Subsequently there is not testing for statistical significance.
- The timescale for the project was truncated due to a variety of factors. This included a change in the delivery method of the additional financial capability activity, from workshops to more tailored one to one advice. This impacted on the numbers of survey returns and, to some extent, the project methodology.
- This report is relevant to all stakeholders and policymakers with an interest in financial capability interventions among patients suffering from serious and chronic health problems.
- 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.
Financial Capability of patients attending NHS units for Renal Services and Inherited Metabolic Disorders full report