Financial difficulties can lead to poor health. This contributes to the large differences in health between people with low incomes compared to those with higher incomes. In recent years people in places like Liverpool have been experiencing increasing financial difficulties, these are getting even worse due to the effect of the COVID19 pandemic on the economy. Problems with debt and low income are particularly increasing mental health problems, leading to more people using health services. Health services, however, can potentially help people manage these financial problems better. Health services in Liverpool have been working with the charity Citizens Advice, to provide people using health services with advice and support, for example helping them apply for welfare benefits, manage debt and improve their housing situation. This service, called Advice on Prescription is expected to see around 30,000 people by the end of 2022. Many NHS organisations are investing in similar initiatives, however, we do not know whether they lead to improvements in health or whether they are good value for money to the NHS.

This research project will work out whether the Advice on Prescription service has improved people’s health, what parts of the programme worked best and how the cost of achieving any benefits compares to other activities the NHS could spend its money on. Using data from health services and Citizens Advice, are comparing the health of people who have used the Advice on Prescription service with a group of people with similar characteristics who have not used this support. We will then compare how the health of adults, and their children changes in these two groups, before and after the intervention. We are estimating how much it costs to deliver the service so we can compare the health benefits from investing in this service to the health benefit of investing the same amount of money in other health services. As the number of people receiving the intervention is very large, this is enabling us to understand, whether it is more or less effective in some health services compared to others or in some patient groups compared to others. We interviewed people using the service to understand how their experience of it has influenced their health and wellbeing.

Working with service users, other members of the public, charities and NHS organisations across the country, we will use the findings to make recommendations about how to introduce similar services in other parts of the country.

January 2024 Update

Download the January 2024 ‘Evaluating Liverpool Citizens Advice on Prescription’ presentation here (CAP) here.

Evaluating the health impact and cost-effectiveness of Advice on Prescription 2 year evaluation Report 2023

Liverpool Citizens Advice on Prescription
Interim evaluation report – January 2023

This report outlines initial findings from the evaluation by the University of Liverpool of the Citizens Advice on Prescription (CAP) service. Citizens Advice on Prescription is a service provided by Citizens Advice Liverpool (CAL) and commissioned by the NHS. It provides a rapid response for people using primary health care services to social welfare advice and support. For secondary care patients, there is an added offer of wellbeing support helping patients connect to community activities and services. The service started in primary care in 2015 and has subsequently been rolled out across multiple health services, most recently the perinatal pathway. The evaluation includes several components, including analysis of data extracted from the services case management system, a quasi-experimental analysis using linked data and a matched control group, interviews with service users and stakeholders and an economic evaluation. This report only includes findings based on analysis of data extracted from the services case management system. Some of the interviews with service users and the other components have not yet collected and analysed sufficient data to draw conclusions.

The analysis shows that there were approximately 50,000 referrals to CAP, from 25,000 people between January 2018 and August 2022. Service use doubled during the pandemic and has remained 50% higher than pre-pandemic levels during 2022 with a large majority of the service users reported having a long-term mental or physical health condition or disability. There has been some improvement in targeting the service to populations living in more deprived areas, mothers and babies, and black and ethnic minority groups. Welfare benefit, housing support and debt advice remains at the core of the service offered by CAL. Besides, the interaction between health problems, financial insecurity and negotiating the benefits system were a common theme driving need for the service amongst clients interviewed.

Initial findings also indicate that the service seems to be associated with improved patient assessment of their own overall health and a decrease in anxiety/depression. Importantly many of these improvements appear to be greatest in the more disadvantaged groups. Given the service is being used by a highly socioeconomically disadvantaged segment of the population, these initial findings indicate that the service could play an important role in reducing health inequalities and reducing demand on health services.

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