Joined-up solutions: partnering advice and health
There is a growing body of evidence linking advice on social welfare problems with addressing health inequalities. It follows the work of Professor Sir Michael Marmot, who coined the term 'social determinants of health' in his report to the Blair government on UK health inequality.
The fact that it is gaining traction is significant to Law Centres because it could lead to developing additional areas of work funded from health and care budgets - as stipulated, for example, by the Care Act 2014. The Low Commission has already identified this as a likely growth area for the advice sector in its second report earlier this year (see its part 4).
Here are some resources to help you make the case for funding your Law Centre to provide health-integrated advice services.
How do advice services achieve health outcomes?
This report, published in June 2015, offers two useful summaries. Firstly, it looks at what research and evidence tell us about the role of legal and advice services in getting better physical and mental health outcomes.
Secondly, it takes stock of the various local advice-health partnerships currently across the UK. This is the document to use when a local or regional commissioner is not convinced that advice improves people's health, thereby saving the public purse valuable funds.
For more resources on this topic, see also the Equality and Human Rights Commission's health inequalities reading list.
Legal advice and better mental health
In August 2016, the Mental Health Foundation published a report on the complex relationship between poverty and mental health, commissioned by the Joseph Rowntree Foundation.
The report highlights, among others, the role and impact of advice, especially legal advice, in preventing mental ill-health or alleviating it. It is an important acknowledgment of the importance of advice, coming from outside of the advice sector.
The potential for more NHS work with charities
In April 2016, the Richmond Group of large health charities have commissioned a report from NPC, arguing that the NHS could do much more to tap into the potential of charities to improve shared outcomes. In a nutshell, using charities more could not only improve service delivery but also better inform system change.
The report highlights health charities but the case it makes could easily be applied to Law Centres, too. Examples of welfare rights advice given by Mind or Macmillan could be eclipsed by Law Centres' ability to challenge decisions and sanctions, and to provide joined-up legal support for multiple problems involving, say, housing or discrimination.
A more manageable summary report is available as well. Note the use of visualisations; the structure of 'pathways', which is how NHS plans much of its services; and the emphasis on 'a shared language', which is often a hurdle for outsiders trying to communicate with the healthcare system.
Bigger contractors are not always better
Many public authorities seem to take it as a given that commissioning public services to fewer, larger providers is better, not least because they can generate economies of scale.
This research, from umbrella body Locality, suggests that this is not the case - especially when it comes to dealing with disadvantaged people or multiple an complex needs at a local level.
Establishing need: how is my local area doing?
There are several official statistics and assessments that you can use to support your case for funding a service - by a public authority or by a charitable funder.
A comprehensive set of the most up-to-date national statistics, searchable by topic, place name or postcode. You can view the results in text and figures or have them mapped out for you. For particular figures, search 'find statistics for an area'. For an overview, search 'neighbourhood summary' - which can also print out a nifty comprehensive report.
PHO indicators use an red/amber/green report card system to reflect how a local area is doing. They cover not just health-specific data like life expectancy, but also wider, social determinants of health: from child poverty and domestic abuse, through violent crime and homelessness, to fuel poverty and social isolation. Data is freely available to browse or download as a handy report.
Public Health England publishes annual profiles, updated every summer, for every local authority area. The reports, downloadable or interactive online, overlap with PHO statistics (above) and give a concise overview of an area, especially with regard to health inequalities (e.g. by gender or ethnicity).
Joint Strategic Needs Assessments
For some time health and care services have been coming closer and closer together, and JSNAs reflect this. They are drawn up by each local authority's Health and Wellbeing Board (HWB), so should be available through your local authority's website. They are an important point of reference if you think of bidding for a Care Act-related advice and information commission: they analyse the local population's profile and its health and wellbeing needs - the ones that they seek to address.
The NHS has created a set of tools to help local Clinical Commissioning Groups (CCGs) prioritise spend on health interventions that are most relevant to their local patient groups. If you want to understand the conditions of greatest concern to your local CCG, or if you are planning services targeted at people with particular health conditions (this can overlap with Troubled Families services) - these reports are for you. They are conveniently divided into medical and care pathways, by region and CCG.
The news often covers deprivation nationally or regionally, but what is it like locally where you are and how does that compare with elsewhere? The indices cover vital areas such as income, employment, health, education and training, crime, housing and local services. The main research report is posted separately here, and there is also a very useful interactive map for the most commonly used indicator, that of multiple deprivation.
This annual statistical snapshot captures wellbeing at local, regional and national levels. Wellbeing is measured by four main aspects, including life satisfaction, anxiety, anxiety and feeling that the things you do in life are worthwhile. The publication also captures local fluctuations from previous years. If you are unsure why this matters, check out the dedicated section on how wellbeing data can and does get used in public policy.
What next: whom to contact?
Each of the regional VCS networks that comprise Regional Voices has produced a guide for its region with key people working in health, wellbeing and care in each region. Updated nearly every month, the guides include relevant people from clinical commissioning groups, health and wellbeing boards, CQC, NHS England area teams, commissioning support units and local Healthwatch. Click here for the latest guides.
OSF Good Practice Guide - July 2015
The OSF Public Health Programme has produced a good practice guide for "Justice Programmes for Public Health". It was clearly drafted for the broadest frame of reference - it does not mention the UK once - but it is nonetheless useful for Law Centres.
Firstly, the guide is comprehensive and covers every stage of service design, from selecting target groups to monitoring and advocacy of the new health-legal project. Secondly, it is a good one to cite, to funders and commissioners alike. Let us know how you find it!