evaluation
Evidence type: Evaluation i
Information about the programme design and rationale
Evidence about Financial Capability outcomes for programme participants
Evidence that the Financial Capability outcomes were caused by the programme
Evidence about programme implementation, feasibility, and piloting
Evidence about relative costs and benefits 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]
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 benefits 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 were 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 then reviewed.
The evaluation included a baseline and follow up survey, for which there were 152 baseline and 78 surveys returned respectively. A control group who received no direct intervention was included in the evaluation. A set of 28 qualitative interviews and observations with medical staff, patients and project staff were also commissioned to review project process and outcomes. Eight patient case studies were produced.
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 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.
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.
The project processes worked effectively, with very high levels of confidence shown in the project team by patients and by health staff. Patients and clinical staff reported the ease and efficiency of the referral and intervention process.
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. Welfare advice and financial capability support delivered together is considered a strong working model, based on interviews with healthcare staff and patients.
Diagnosis and treatment for renal failure had in the majority of cases led to patient’s livelihoods being lost. This seriously disrupted their family life and relationships, causing negative financial and emotional impacts on patients. Patients were also facing challenges around the definition of disability related to the changes within the welfare benefit system. Few patients had any financial buffer against the impact of being diagnosed with renal failure, or their savings had run out.
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. This increased their household budget and reduced the stress on individual patients and their families. Patients reported that they were able to budget more effectively as a result, and ‘getting by’ when they had previously been unable to cope or struggling. A number of 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 restabilised, as well as managing repayments for arrears more effectively.
Patients described a variety of positive changes that came about with their increased income including: being able to make improvements to their diet making it more suitable for their health condition; heat their houses without worry; and keep themselves and their houses cleaner with less concern about water bills. Other improvements for individuals were: increased feelings of independence through the ability to continue to drive and park using a Blue Badge; being safer and more independent in their own homes with additional aids and adaptations to enhance their mobility; and an ability to feel secure in their tenancies or with their mortgages where appropriate repayment plans were arranged.
The survey indicated a slight improvement in the attitudes and confidence of a small number of patients outside the control group towards financial capability matters, including shopping around for the best deals. The proportion able to use the internet to access services remained very low, however. Questions regarding planning ahead, feeling in control and buying things to cope with their health condition showed higher scores by survey 2. The survey indicated that for welfare benefits and financial advice respondents would still prefer to see a specialist advice worker, although their confidence to claim benefits increased, as did their confidence to speak with friends and family about their finances. No changes in attitude were evidenced amongst the survey responses for the control group.
A majority of patients interviewed recalled discussions with the project team around financial capability matters, especially regarding utilities and tariffs. 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. Information being delivered appropriately by a knowledgeable project worker, adapted to the knowledge level and situation of the individual patient, therefore appeared to be both preferred and more effective.
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. Where patients had previously had strong financial capability, with support from the project team, changes in confidence and financial decision making were strongest.
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. However, change was not yet apparent in this group regarding their ability and confidence to manage their financial affairs independently, usually inhibited by low digital confidence or ability. A number of factors would have to interplay to determine whether they had the capacity to change over a longer period and would also be dependent on health, family and management of post diagnosis psychological crisis. Longer-term follow-up would be required to check if behaviour change could be consolidated.
These two patient groups are particularly hard to research due to their health and the mental health issues arising from their conditions. Additionally, their complex medical schedules of appointments and treatment adds logistical complications to the research. The project participants frequently experienced health and financial crises which made consistent and reliable data hard to collect. Qualitative interviews with patients and health staff have proven the most effective means of evaluation, and patients generally responded well to one to one discussion.
The patient survey, especially the baseline survey, provided a valuable indicator of the views, attitudes and behaviour of renal patients, but did have a number of limitations. These relate to:
Qualitative interviews have given a good level of information and opinions which indicate potential transferability to other healthcare contexts, especially other renal dialysis centres, but also other patient groups with chronic debilitating illnesses. Causality of change is difficult to establish, but alongside supportive family and positive health care interventions, the project has provided an indicator of the benefit of financial capability work in healthcare settings. Patients had typically not sought support from elsewhere before contact with Auriga indicating that these patients may well have fallen through the net without the project. The project also provides valuable insight into these under researched groups. Learning and sharing of the insights gained has taken place throughout the project, through training, conferences and social media.
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