people with low incomes and those with higher incomes. In recent years, people in areas like Liverpool faced worsening financial challenges, amplified by the COVID-19 pandemic’s economic impact. Problems with low income and debt particularly exacerbated mental health issues, and increased reliance on health services. Health services can, however, play a pivotal role in helping people manage financial problems.

Health services in Liverpool partnered with the charity Citizens Advice to offer advice and support, helping people apply for welfare benefits, manage debt, and improve their housing situation. This service, called Advice on Prescription, was expected to reach around 30,000 people by the end of 2022. While many NHS organisations had similar initiatives, it was not known whether they had led to measurable improvements in health, or whether they offered good value for money to the NHS.

This research investigated whether the Advice on Prescription service had improved people’s health, identified which parts of the programme worked best, and assessed how the cost of the service compared to other potential NHS expenditures (value for money). By analysing data from health services and Citizens Advice, the study compared the health of those who had used the Advice on Prescription service with a similar group who had not. It tracked changes in the health of adults and their children in both groups, before and after the intervention. It estimated the cost of delivering the service, enabling a comparison of health benefits from investing in this service versus other health services. With such a large number of participants, the study also helped uncover whether the service was more or less effective in certain health services or patient groups. Interviews with service users were conducted to explore how their experiences influenced their health and wellbeing.

Collaborating with service users, the public, charities, and NHS organisations across the country, the research aimed to use its findings to recommend how similar services could be rolled out in other regions.

The final report which valuates the health impact and cost-effectiveness of Citizens Advice on Prescription, a whole system approach to mitigate poverty over the life course can be found here.

When You Know: Childbirth in the asylum system

This film which was created as part of the project explores themes of displacement, isolation, fear, health inequities and inequalities, intersectionality, and the maternal health consequences of common structural barriers encountered by people giving birth in the asylum system.

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, a service provided by Citizens Advice Liverpool (CAL) and commissioned by the NHS. It provides rapid social welfare advice and support for people using primary health care services. For secondary care patients, there is an additional offer of wellbeing support that helps 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 involves 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 focusses on findings from the analysis of data from the services case management system. Findings from analysis in the other components will follow.

This analysis revealed 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 remained 50% higher than pre-pandemic levels during 2022. A large majority reported having a long-term mental or physical health condition or disability. There was 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 remained at the core of the service offered by CAL. Besides, the interaction between health problems and financial insecurity, negotiating the benefits system were a common theme driving need for the service amongst clients interviewed.

Initial findings also indicate that the service is 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 that the service is being used by a highly socioeconomically disadvantaged segment of the population, these initial findings indicate that it could play an important role in reducing health inequalities and reducing demand on health services.

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