Citizens Advice Bureaux
in General Practice
Report 2011/12
Introduction
The Derbyshire Citizens Advice Bureau in GP Surgeries project continues to help the most vulnerable in our communities and, as the statistics show later in this report, the CABx continue to deliver improved value for money for the public purse and commissioners. To illustrate the continuing need for the service, extracts from two key reports are quoted below.
‘Action is needed to reduce the impact on health inequalities from recession and welfare changes’The Institute of Health Equity is calling for action by local and national government to
reduce a potential increase of health inequalities in London as a result of the economic
downturn and welfare changes. Commissioned by the London Health Inequalities Network, the IHE has analysed evidence from previous economic downturns across the world to identify some of the likely impacts on health and health inequalities in London by 2016 with particular emphasis on three key social determinants of health: employment, income and housing’ (Institute of Health Equity, Press Release, 19th June 2012).
‘I observe this again and again that I cannot address medical issues as I have to deal with the patient’s agenda first, which is getting money to feed and heat.’
In my surgery I am hearing from patients who for 2–3 days a week cannot afford to heat their houses (many use metered cards which are more expensive than direct debit payments)’.
‘Many patients are:
struggling to make ends meet
increasing contact with GPs and psychiatry
increasing antidepressant/antipsychotic use
self-medicating with drugs and alcohol’
(Excerpts from GPs At The Deep End, University of Glasgow 2012)
In Derbyshire, our GPs also face many of these issues on a regular basis. The health community in Derbyshire is charged with reducing inequalities in health in the most challenging economic environment for decades. This project continues to mitigate the impact of the downturn on our population. For example, in 2011/12 CAB in GP surgeries:
Provided help and advice to 5,857 separate patients or families
Advised on 29,673problems
Secured additional income of £7,698,310
Rescheduled or managed £8,138,401 of debt
46% of clients received additional income or one-off payment
The CAB service remains popular with patients and GPs and is seen as an integral and valued component of Derbyshire’s primary health care service. From April 2013 responsibility for public health moves from the NHS to local authorities. It is hoped that this will further strengthen our collective approach to promoting public health and reducing health inequalities in Derbyshire.
Julie Hirst, Public Health Specialist, NHS Derbyshire County
Stephen Minter, on behalf of the five Citizens Advice Bureaux in Derbyshire.
Derbyshire Citizens Advice Bureauxin General Practice 2011/12
Statistics
Headline Statistics
2009/102010/11 2011/12
Clients seen3,4905,5875,857
Contacts11,64116,69717,138
Problems dealt with18,58926,14129,673
Financial gains£4,545,623£6,941,558£7,698,310
Debt advised£7,660,593£8,098,016£8,138,401
Cost per client£187£141£131
Cost per contact£56£47£45
Cost per problem£35£30£26
Cost to commissioners£790,000£753,966£767,377
How do we define service users and what do we count?
Client
A person who contacts the Citizens Advice Bureaux with a new problem during a specified period (usually 12 months).
Any client who contacts the CAB more than once, about any matter, during a specified period will only be counted once
Contact
This counts the number of times a client makes contact with the CAB or the CAB makes contact with the client. This may be face-to-face, by telephone, letter or email
Enquiry
An enquiry counts the number of issues or problems that a client seeks help with. Many clients have more than one issue or problem, even if the only perceived problem is, for instance, debt. Within a debt problem there may be a housing issue (possible eviction due to rent arrears), a utilities issue (possible disconnection due to arrears) and a money-lending issue (illegal doorstep lending). We count this as three enquiries as there are three separate legal issues, demanding different and separate courses of action.
Client Statistics
GP Project 2011-12Q1 / Q2 / Q3 / Q4 / Total
New
Clients / Total
Unique
Clients
Amber Valley / 253 / 210 / 215 / 276 / 529 / 879
Chesterfield / 197 / 242 / 209 / 295 / 699 / 919
Derbyshire Dales / 126 / 118 / 98 / 130 / 227 / 429
Erewash / 177 / 163 / 164 / 208 / 532 / 660
High Peak / 210 / 211 / 209 / 286 / 525 / 850
North East Derbyshire / Bolsover / 365 / 386 / 351 / 482 / 1,030 / 1,482
South Derbyshire / 139 / 184 / 165 / 184 / 490 / 638
Total / 1467 / 1514 / 1411 / 1861 / 4032 / 5,857
* Total clients for the whole year will be less than the combined total of the quarters, as clients who attend more than once in a period are counted once
Where from?
Quarterly Clients 2011/12
Contact Statistics
GP Project 2011-12Q1 / Q2 / Q3 / Q4 / Total
Amber Valley / 706 / 665 / 643 / 723 / 2737
Chesterfield / 468 / 500 / 417 / 558 / 1943
Derbyshire Dales / 310 / 307 / 286 / 317 / 1220
Erewash / 410 / 353 / 433 / 556 / 1752
High Peak / 630 / 587 / 623 / 727 / 2567
North East Derbyshire / Bolsover / 1142 / 1136 / 1037 / 1331 / 4646
South Derbyshire / 453 / 559 / 582 / 679 / 2273
Total / 4119 / 4107 / 4021 / 4891 / 17138
Where from?
Quarterly Contacts
Enquiry Statistics
Total issues 2011/12Category / Q1 / Q2 / Q3 / Q4 / Total
Benefits / 3818 / 4195 / 3866 / 5097 / 16,976
Consumer / 48 / 60 / 53 / 68 / 229
Debt / 1734 / 1501 / 1416 / 1965 / 6,616
Education / 12 / 33 / 17 / 32 / 94
Employment / 292 / 370 / 252 / 367 / 1,281
Health / 108 / 105 / 119 / 182 / 514
Housing / 285 / 258 / 237 / 280 / 1,060
Other / 657 / 732 / 605 / 909 / 2,903
Total Issues / 6,954 / 7,254 / 6,565 / 8,900 / 29,673
Financial Outcomes for Clients
Income gains £7,698,310
Amount of debt advised /renegotiated£8,138,401
Cost to PCT
Revenue cost £767,377
Cost per client£131
Cost per client contact£45
Cost per problem £26
Clients/families receiving additional income2,712
Clients with one-off financial gain368
Average financial gain by client/family£2,839
Every £1 invested by PCT secures £10and manages £11of debt for clients
Case studies
Case study 1
Harriet approached the service in November 2011, following a diagnosis of Atrial fibrillation, causing significant tiredness and shortness of breath. She works 20 hours a week and finding it difficult to meet her financial obligations. She was in receipt of a small amount of housing and council tax benefit paying approximately £40.00 a week to the Local Authority.
A claim for Disability Living Allowance was made and supported by her GP and Harriet was delighted to receive an award of High Rate Mobility and Mid Rate Care Disability Living Allowance. This award was indefinite and increased her weekly income by £105.90.
Following the receipt of a successful Disability Living Allowance award, a passported benefits check was undertaken by the CAB adviser. Harrietwas advised to make a claim for Working Tax Credit, as she fulfilled the criteria for the disability element of Working Tax Credit. She worked more than 16 hours a week and was in receipt of a qualifying benefit. Harrietwas awarded £87.88 per week Working Tax Credit. Also, a reapplication for Housing and Council Tax Benefit was submitted. Harriet was awarded full Housing and Council Tax Benefit totalling £85.27 a week. A gain in income of at least a further £40.00 a week.
Harrietwas also advised to apply for Gold Card in order that she is able to travel free of charge between certain hours on public transport. She has applied for a Disabled Person’s Railcard (£20 per annum), entitling her and travel companion to a third off all rail journeys within the United Kingdom. She has a Cinema Exhibitors Card (£5.50 per annum). She received a Bite Card (free of charge) offering 20% off at food and drink outlets based in UK mainline railway stations.
Due to the client’s disability and also the fact that she is living in a two bed roomed property which is too large and unfit for her needs, we are currently in the process of assisting Harriet toobtain a bungalow which will more suitable for her medical needs.
In total, Harriet’sweekly income has been increased by £233.78.
This represents an annual income increase of £12,156.56.
Harriet commented that she could take her first short holiday in 3 years due to the extra income she is now receiving. She remarked “You cannot believe the difference you have made to my life, I want to thank you so much for your help, I can now sleep at night”
Case study 2
Thomas (aged 45) was referred to us by his cousin who had used our service before at her local bureau. Due to his severe mental health problems Thomas needed to be accompanied to his first appointment as he couldn’t interact with strangers.
Thomas was caught in a benefit trap. He was deemed capable of work via an Employment & Support Allowance assessment but was told he too ill to work when he applied for JSA when disclosing his mental health problems.
He hadn’t claimed any benefits for a number of months and couldn’t see a way out as every way he turned, he was turned away. Subsequently he was in arrears with his rent, council tax, electricity and in addition he had a housing benefit overpayment which meant his housing benefit was reduced which had a knock on affect of increasing his rent arrears as they were paying less housing benefit because of the overpayment but his rent remained at the same level.. He had received a Notice Seeking Possession from his Landlord and was under threat of eviction. Thomas also had some social fund loans to repay and some small debts relating to previous self employment.
Thomas had no phone and was very isolated. He had taken the drastic step to have his gas supply cut off as he had no money for the standing charge let alone enough to pay for his current usage. He was washing himself and his clothes by boiling a kettle and the only heat he had was a fire in his front room using logs he could pick up for free in local woods. He wasn’t eating properly and was unable to support his adult daughter who lived with his ex wife.
Gradually the GP worker gained his trust and he attended various appointments on his own to resolve his benefit and debt problems.
With our support he re applied for Employment & Support Allowance. After initially being turned down yet again for this benefit, we helped him lodge an appeal and remain in benefit. Eventually he was accepted for the benefit and placed in the work related activity group (extra £26.75 per week) without the appeal going ahead after we highlighted his health problems.
We also helped in claim Housing Benefit and Council Tax benefit and asked for the benefit to be backdated further than usual as we felt he had “good cause”. To do this we liaised with his mental health worker to provide evidence to the Local Authority. This was successful and cleared all of his council tax arrears and the majority of his rent arrears.
As part of our service we negotiated with his landlord a plan to pay off the arrears by manageable instalments to stave off eviction and negotiated with his electricity supplier to pay his arrears by reasonable instalments meaning he would not need to install a pre payment meter would not have been ideal in his current financial situation ie paying off arrears out of any top up to the meter meaning potentially he could be without electricity.
At the same time as dealing with his debts and benefit issues, we applied to the Local Authority’s repossession fund and were eventually successful in obtaining a grant to clear the remaining arrears thereby removing the threat of eviction.
The remaining debts were negotiated to £1 per month.
We worked on budgeting and maximising his (benefit) income so that Thomas has enough for food and heat and be able to pay off his debts and pay a small amount to his daughter.
A few months since bureau intervention the client advised me that he is:
- Looking to try employment again
- Had his gas reconnected
- Mental Health has improved since the worry of his debt and the threat of eviction has lessened
- Feels that he is “paying his way”
- Will be debt free within a year
Benefit Gains: £9850
Financial assistance from council £475.09
Backdated benefit payments: £938
Debt Written off: £88.05
As a result of positive feedback, his cousin came back to the surgery and we successfully obtained a Community Care Grant and increased her dependant sister’s benefits.
Case Study 3
Matthew attended his appointment at a southern Derbyshire GP Practice with his mum. He has severe mental health problems and had run up a number of debts with payday loan companies, in receipt of a small benefit income he was unable to pay the ever-increasing amounts being demanded by his creditors.
Our adviser sat with Matthew and established his income and his expenditure, it was clear that he could not afford to repay the debts and that his financial situation was worsening his mental health. The adviser explained all available options to Matthew from small token £1 monthly offers to insolvency measures which would write off the debt.
Matthew decided that he would like a complete fresh start and have the debt written off in full. The adviser booked Matthew an appointment to see our specialist Mental Health Money Adviser, she helped Matthew to apply for a Debt Relief Order. A Debt Relief Order costs £90 and is an insolvency measure for those who have under £15,000 worth of debt, no assets and surplus income of less than £50 per month. Matthew was an ideal candidate.
The Debt Relief Order has now been approved and Matthew is debt free and enjoying a fresh start and improved mental health. Matthew’s experience has been used by Citizens Advice as evidence to highlight the way in which pay day lenders treat their customers and to campaign against excessive interest charges and fees which are regularly applied to pay day loans.
Total debt written off: £4606.
Case study 4
Niall and Janna (not their real names) came to the outreach session on the advice of the Jobcentre and their GP, for help to claim disability benefits for their school-age daughter with severe learning difficulties. Their daughter has a statement of special needs, as well as several specialist reports about her cognitive abilities and limitations. Niall claims income-based Jobseekers Allowance, and Janna cannot work because their daughter has regular hospital appointments. They rent privately and claim housing and council tax benefits, as well as child benefit and child tax credit, and their income is £249.65 per week (before April 2012). They brought the DLA (child) claim form with them.
This couple is already on means-tested benefits, so I explained that a successful claim for DLA would have a ripple effect on other benefits they could claim, entitling them to a disability premium on their child tax credit award and Carer’s Allowance for Janna.
Claiming DLA for a child is particularly difficult, because the parents must compare the needs of their disabled child with those of a non-disabled child and assess how much more attention their disabled daughter requires. But Niall and Janna were able to describe their daughter’s needs very clearly and I felt confident that their daughter would qualify for both mobility (low rate) and the middle rate of the care component. We began to fill in the complex DLA form in the time remaining, but needed another appointment slot to finish the job. Janna had obtained a letter of support from her daughter’s special needs teacher, which we included with the claim form.
The couple received a decision after five weeks – their daughter had been awarded only the low rate of the mobility component, and no care component at all. Janna was dismayed at this award, believing that her daughter’s care needs were more troublesome than her mobility. I advised them that they were within the time period to dispute the decision on any grounds, and they decided to ask for a review, or second opinion. I also helped them compose a letter to submit, explaining in detail their daughter’s difficulties and the help she required from them.
Four weeks later, Niall returned to report that, despite our lengthy and detailed letter, the review process had resulted in their daughter’s mobility component being removed altogether, a completely unexpected result. Janna was prepared to give up at this point, but I persuaded them to continue with an appeal, stressing the independence of the tribunal which has the power to overturn bad decisions. Because they received an income-based benefit, JSA, they were eligible to see our legal aid adviser who could help them through the appeal process, and they were very pleased to learn that they would not have to go through this ordeal on their own.
Niall and Janna attended the appointment with the legal aid adviser, who explained the appeal procedure and wrote to their GP asking for a letter of support.
Then – a surprise. Niall returned the following week to report that, as a consequence of the appeal being filed, their daughter’s claim was looked at again, and this time, the decision maker had awarded them the lower rate of mobility and, significantly, the middle rate of the care component. Janna was elated. We arranged an appointment for the following week so that Janna could claim Carer’s Allowance and the disability element on their child tax credit. They could also choose to exchange Niall’s JSA claim for Income Support, which Janna could claim as a carer. However, Niall wanted to continue to look for work. Janna was later awarded Carer’s Allowance, and their tax credit award was increased.