Description of the programme
[This is an extract from the Executive Summary of the evaluation report. Further amendments may be made to this Summary, pending review by the Evidence Hub partner]
Shelter Scotland’s Healthy Finances pilot aims to reach particularly vulnerable and excluded individuals who are unlikely to seek support with their financial and housing difficulties and only engage with services when they experience medical problems. It works with people aged between 16 and 64 presenting at selected primary health care services such as GP practices and hospitals in the most deprived areas of Dundee and Glasgow. Clients are referred into the pilot service from their primary health care provider and receive longer-term one-to-one support with financial and housing difficulties. 153 clients received support between January 2017 and January 2018.
The Healthy Finances pilot was designed to test two research questions:
- That placing a service within primary health care services helps to engage with clients that would not have previously engaged with financial capability services – ie they were ‘under the radar’
- That providing longer term support provides more sustainable positive outcomes that shorter interventions.
This evaluation seeks to answer these two questions as well as measure the extent to which the MAS What Works Fund Outcomes are achieved.
The main purpose of the evaluation presented in this report, is to assess the outcomes of the pilot for clients in terms of housing and financial wellbeing, and the role of the core features of the pilot – longer-term engagement, holistic support with a range of issues, and referrals from primary health care – in generating and maximising these outcomes.
The evaluation took place between February 2017 and February 2018. The following methods were used to collect data:
- 18 interviews with pilot staff: Six pilot staff (three in each city) were interviewed at the beginning, midway through, and at the end of the evaluation phase
- Two case study interviews with pilot staff: Two case study interviews were conducted with pilot staff (1 from each city) about the journeys of 20 clients (10 in each city) at the end of the evaluation phase
- 18 interviews with staff in primary health care settings: Six health sector staff (three in each city) were interviewed at the beginning, midway through, and at the end of the evaluation phase
- 17 interviews with clients: Seven clients were interviewed midway through, and 10 clients at the end of the evaluation phase
- Quantified analysis of 153 client forms: We analysed the client forms of all clients who engaged for more than an initial meeting during the evaluation period.
What are the outcomes?
- Increased income
- Reduced debts
- Improved ability, motivation and confidence to manage money well
- More stable, affordable or appropriate housing secured
- Improved quality of housing
- Clients’ housing situation has improved considerably including more stable, affordable and appropriate housing [project specific outcome].
- Clients’ financial wellbeing and behaviour has improved considerably, including an increased income and reduced debt [MAS Financial Wellbeing and Financial Behaviour outcomes].
- For a sizeable number of clients, an insufficient ability, confidence or motivation to manage their finances well appeared not to be at the root of their housing and financial issues, but rather a consequence of them [MAS Ability and Mindset outcomes].
- Improved housing situation and financial wellbeing has led to improved mental health.
- Referrals from primary health care improves access to financial and housing advice for clients whose needs are otherwise unmet.
- Offering more holistic support with a range of issues, including housing and finances, has helped achieve additional outcomes.
- Offering longer-term engagement, where needed, improves outcomes.
- Several factors can enable and encourage longer-term engagement, but a relationship based on trust between frontline staff and clients is key.
- Referrals from GP practices, which account for the majority of referrals, were most likely to reach the intended group of new clients with unmet needs.
- Health staff perceive the collaboration with Healthy Finances pilot staff overall as effective and low-burden.
- Health staff would welcome a permanent provision of the Healthy Finances service, with increased capacity.
- The pilot helps relieve some of the pressure on primary health care.
Implications for policy and practice
- Those who belong to the “struggling” segment of society according to the Money Advice Service (MAS) segmentation model (MAS 2016, p. 5) have a particular need for advice around benefit
- Service design and delivery can foster longer-term engagement, which can in turn improve financial and housing outcomes:
- Removing barriers related to stigma around financial and housing difficulties such as offering support in close collaboration with primary health care, which is less stigmatised
- Removing barriers related to health issues, such as offering home visits
- Contacting people on a regular basis and asking them how they are and if they would like more support
- Establishing trust appears to be crucial to enable longer-term engagement with particularly vulnerable clients.
- More holistic advice on a combination of financial and housing issues can have additional benefits compared to more specific and restricted advice
- Collaborating with primary health care can improve access to financial and housing advice for certain parts of the “struggling” segment of society according to the MAS segmentation model (MAS 2016, p. 5)
- Support with housing and financial difficulties can relieve some of the pressure on primary health care
- When collaborating with support services, primary health care settings value low-burden processes, services being responsive, and feedback on patients’ progress
- There is a need for the permanent provision of the type of support offered by Shelter Scotland’s Healthy Finances pilot, with increased capacity.
Points to consider
- The evidence produced is at level 2 out of 5 on the Nesta Standards of Evidence scale.
- The actual number of outcomes achieved with clients might be higher, because not all outcomes appear to have been recorded in client forms.
- Monitoring the outcomes for clients over a longer period, and after support has ended, would be required to test the sustainability of outcomes.
- The case study interviews cover a good sample of more than 10% of the overall client population. However, they did not allow us to quantify outcomes in terms of clients’ ability, motivation and confidence to manage their money well day-to-day.
- Selection bias due to the way in which interviewees were selected might lead to overly positive findings in some areas.
Health Finances Pilot final evaluation - full report