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Dr Anne Mullen, Chair, Deep End Group Scotland

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Dr Anne Mullen, Chair, Deep End Group Scotland SSC/S5/19/BTU/57 SOCIAL SECURTIY COMMITTEE BENEFIT TAKE-UP SUBMISSION FROM: DR ANNE MULLEN, CHAIR, DEEP END GROUP SCOTLAND DEEP END MONEY ADVICE PROJECT BACKGROUND For 2014/15, Glasgow Calton was judged to be the worst affected ward in the UK by welfare reform; an estimated £880 a year per working age adult was to be removed from the local economy, largely due to changes in incapacity benefits1. Since then, the four year benefit freeze has reduced the real-terms value of most working-age benefits, and the two- child limit has denied entitlement to thousands of families. THE PROJECT Since December 2015, the Deep End Money Advice Project has gradually embedded the delivery of money advice in 17 Deep End GP Practices in North East Glasgow. Deep End Practices serve the most socio-economically deprived populations in Scotland. The majority of the Practices in the Project are in the Glasgow Calton ward. GEMAP Scotland Ltd. Money Advisors are embedded in Practices in three GP clusters (Parkhead, Bridgeton and Dennistoun) for half a day per Practice per week. Advisors can access patient medical records (with consent) to assist completion of high quality benefit applications / reviews / appeals thus reducing the risk of vulnerable people spending unnecessary, and potentially stressful, time in the system. Typically, money issues raised by patients in GP Practices are more complex than in other settings2. GOVERNANCE The project is managed by the North East Health Improvement Team (Glasgow HSCP) and overseen by an Advisory Group which includes two GPs and representation from the Scottish Deep End Project, Clyde Gateway, Glasgow Centre for Population Health and GEMAP Scotland Ltd. Project updates are regularly provided for GP clusters and the Primary Care Locality Implementation Group. FUNDING The Project is currently funded by Glasgow HSCP and Clyde Gateway (to March 2020). Previous funders include the Wheatley Group and Healthcare Improvement Scotland. Total service delivery costs over the last four years are £185k. This does not include significant Health Improvement staff time required to implement and co-ordinate the Project. At an individual GP Practice level, it costs £5,800 to deliver the service per year. OUTCOMES 2,196 patients were referred by GP Practice staff from December 2015 to November 2019. 1,384 patients engaged with the service, giving an uptake of 66% (pending referrals removed). The majority of service users have not accessed mainstream advice in the last year and evaluation indicates that many households are struggling on very low incomes either unaware of their entitlement to benefits, or they feel unable to seek advice via other routes or settings. 1 SSC/S5/19/BTU/57 Patients have achieved a total financial gain of £5,042,608 over the last four years. A Glasgow Centre for Population Health evaluation of the project (2017/18) identified an average financial gain of £8,254 per patient (median £1,453) and an average debt managed of £4,356 per patient (median £1,993). The total financial gain includes £1,943,441 in devolved benefits and £3,099,167 in other benefits (details below). The devolved benefits include those that are currently administered by Social Security Scotland and those that are still administered by the Department for Work and Pensions. The project has helped patients to negotiate total debts of £1,727,025, composed of £463,406 (housing), £1,032,668 (non housing) and £230,951 (council tax). A crude return on investment analysis indicates that the project generates over £27 in financial gains for every £1 invested. DEVOLVED BENEFITS Attendance Allowance 73 £184,122.56 Best Start Foods 2 £457.24 Best Start Grant 19 £5,963.30 Carer's Allowance 68 £176,255.61 Discretionary Housing Payment 32 £19,433.04 Disability Living Allowance 53 £124,598.40 Funeral Payment 3 £3,644.49 Personal Independence Payments 444 £1,418,368.00 Severe Disablement Allowance 1 £10,598.24 TOTAL 695 £1,943,440.88 OTHER BENEFITS Ancillary Benefits 5 £275.80 Bereavement Allowance 2 £0.00 Budgeting Loan 8 £3,468.00 Child Benefit 27 £34,514.17 Child Tax Credit 39 £189,024.20 CHSS Grant 14 £6,432.11 Clothing Grant 3 £366.00 Council Tax - Single Person Discount 2 £559.19 Council Tax - Student Exemption 1 £0.00 Council Tax Reduction 136 £90,199.78 Employment Support Allowance (ESA) 315 £1,425,658.00 Pension Credit 33 £97,265.20 Housing Benefit / Local Housing Allowance 114 £403,120.90 Income Support 20 £76,753.19 Jobseeker's Allowance (Income-based) 12 £37,375.44 New Style ESA 3 £4,020.50 2 SSC/S5/19/BTU/57 Retirement Pension 4 £31,856.61 Scottish Welfare Fund 95 £28,256.95 Severe Disability Premium 50 £388,499.20 Severely Mentally Impaired Exemption For 2 £2,909.98 C/TAX Universal Credit 59 £259,945.00 Working Tax Credit 10 £18,666.73 TOTAL 954 £3,099,166.95 ADDITIONAL CLAIMS The most common other claims awarded are the Warm Home Discount (58) and Blue Badge scheme (30), with smaller number of patients successful in achieving other claims (e.g. NHS Low income scheme, Free School Meals, Family Fund, Glasgow Care Foundation grant, Education Maintenance Allowance, Bursary, Vicars Relief Fund). PROFILE OF SERVICE USERS • 53% had household income < £10,000 per annum (20% had household income < £6,000 per annum) • More likely to be: unfit for work (54%), social housing tenants (66%), >46 years old (64%), female (57%) • 21% had dependent children (12% were lone parents) KEY FEATURES OF THE PROJECT Patients trust their GP thus they are willing to be referred to a Money Advisor. They value the anonymity of the service and the GP Practice setting is perceived as welcoming, secure, non-judgemental and free from stigma. GPs are much more likely to respond to patients’ money worries if they can offer a solution on-site. They believe the service has a positive impact on patients’ mental health and some report reductions in workload. Money Advisors perceive the GP Practice as a ‘trusted hub’ in which patients are more open about discussing money worries. They believe that gaining access to patient medical records facilitates preparation of high quality advice interventions. New patients continue to be identified and referred by the two pilot Practices four years after the project started, demonstrating that this approach is not a short term fix and requires longer term investment. Embedding money advice in General Practice reaches people who are expected to access advice services but don’t. It generates large financial gains, especially for patients with disabilities and long-term conditions, and moves beyond signposting thus strengthening the safety net for patients. 3 SSC/S5/19/BTU/57 MOVING FORWARDS From 2020, Social Security Scotland will be responsible for delivering post Wave 1 Disability Assistance benefits to 40,000 children (£183 million, summer 2020), 198,000 older people (£869 million, end of 2020) and 281,000 working age adults (£1,575 million, early 2021)3. It is unclear what plans are in place to ensure that these groups access these entitlements but achieving 100% uptake is likely to prove challenging. CONCLUSION Embedding money advice in General Practice increases the likelihood that people on very low income, who don’t access advice, and are entitled to (backdated) disability benefits, are not left behind. The model successfully meets the unmet needs of the population and is accessible to those who need those it most. REFERENCES 1. Scottish Government Welfare Reform Committee, 5th Report (2014), Report on Local Impact of Welfare Reform. 2. Welfare Benefits Advice through General Practices; A Business Case, London: London Health Inequalities Network (2013). 3. Social security: Implementing the devolved powers (Audit Scotland, May 2019). GP TESTIMONIES “The benefit of having an expert money advisor has been enormous. I have had direct experience of patients returning with an improvement in depression and anxiety due to the lifting of a debt burden, the help to negotiate the benefits system and liaising with the appropriate agencies. Patients have trust in the practice. This is a no brainer to me, you put a little in and get a lot out. This affects not just the individuals but also their families and the broader communities. This much needed money is going into some of our most deprived communities.” (GP1) “Patients often present with stress and when you scratch the surface money is a big cause. I feel strongly that in deprived areas patients struggle with idea of going somewhere unknown due to anxiety, transport issues, fear of the unfamiliar and this results in them not using services and DNAs. GP practices are one of the few places that they are prepared to go.” (GP2) PATIENT TESTIMONY “It’s not like walking into a big office, it’s not intimidating, no one knows what I am there for, no big glass windows or anything. Because of that I don’t hold back, I say what needs to be said.” 4 .
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