The following case study looks at action taken by NHS Lanarkshire to mitigate the impact of welfare reform and promote financial inclusion.

Reason action was taken

As noted in our take the right actions page, one of the key ways to reduce health inequalities is by having effective partnerships across sectors.

Poverty and low income in North Lanarkshire

North Lanarkshire is the fourth largest local authority area in Scotland. Within it

• about 15% (52,325) of people are income deprived
• 34% of households are living in fuel poverty
• 61% of those experiencing income deprivation do not live in the 15% most deprived data zones
• 9% (15,060) of children are in low income families which is statistically significantly worse than the Scotland average of 18.4%.

It is recognised that poverty and low income have a major impact on health inequality and that NHS staff have a key role to play in reaching those most at risk of financial exclusion.

Local child poverty action plan

The Child Poverty (Scotland) Act 2017 places a duty on local authorities and NHS boards to jointly develop and publish an annual Local Child Poverty Action Plan. NHS Lanarkshire are working with partners in the statutory and voluntary sectors to improve access to financial information and advice services.

Work is already ongoing to

• increase NHS staff awareness, knowledge and confidence in identifying and providing practical support to patients at risk of financial hardship
• provide clear, direct referral pathways so patients have easy access to financial information and advice services
• remove barriers and stigma which stops some people from accessing the help and support they need
• intervene as early as possible to support income maximisation and prevent financial crisis
• provide intensive support for the most vulnerable children and families by embedding financial inclusion in routine enquiry and assessment processes.

Action taken

Co-located within health care settings, specialist services were set up to offer patients and health staff direct access to information and support on a range of benefit and money related issues.

This included specialist Welfare Rights (WR) advice services in

• Airdrie Community Health Centre
• Coatbridge Community Health Centre
• Wishaw Community Health Centre
• Houldsworth Community Health Centre financial inclusion hub.

There was also work undertaken to embed routine enquiry financial wellbeing questions into core care assessment and referral pathways. A pilot project with health visitors, district nurses and family nurse partnership nursing staff within Airdrie and Coatbridge was set up in October 2018.  The pilot project ended in April 2019 and the results are currently under review. 

NHS Lanarkshire is also involved in a number of joint initiatives which aim to address food and fuel poverty and targeted work with vulnerable communities.

People who helped

Buy-in was needed from senior managers and staff across the organisation.

Strong partnership working was essential. A range of partners from financial inclusion and money advice services (both in the statutory and voluntary sector) were involved in the planning and delivery of services.

Impact and lessons learned

Referrals

There was an increase in the number of patients referred to the Financial Inclusion Services. The total number of people seen by the WR advice services between May 2014 and March 2019 was 1,798. Additional income generated for the users of the service was £2,994,236. The service aims to help to achieve the maximum possible entitlement to benefits.

Between October 2018 and March 2019, the Health Visitor/District Nurse pilot generated 227 additional referrals to the Financial Inclusion Team. Income generated by the pilot will be reported once known.

Cultural change

Cultural change within the health care environment was slow, but there was a definite shift in management and staff attitudes.

There was recognition of the role of the NHS in addressing wider determinants of health that lead to a reduction in health inequalities.

Poverty and financial inclusion are now recognised as a priority for health care staff.

Support and funding

Ongoing work is required to ensure that necessary staff, resources and funding are dedicated to the delivery of key programmes.

More support is also required for evaluation into outcomes and impact.

Further information

You can find out more about ways to reduce health inequalities within our reducing health inequalities section.

This case study is based on information provided by Janice Scouller of NHS Lanarkshire. If you would like to discuss further, you can contact our Health Promoting Health Service (HPHS) team by email at nhs.HealthScotland-hphsadmin@nhs.net.