Citizens Advice Bureaux
in General Practice
Report 2009/2010
Introduction
The Citizens Advice Bureau (CAB) in general practice project continued to grow throughout 2009/10. During this year the number of practices that offered a CAB service increased from 52 in April 2009 to 90 March 2010 (counting Staffa as three and including Ilkeston walk-in centre). The CAB service has been welcomed by most GPs and is seen as an important and valued component of primary care in Derbyshire. Through a combination of planning and serendipity, the expansion of the CAB project occurred simultaneously with the recession. This has helped to mitigate the effects of recession for some our most vulnerable individuals and families, as the outcomes and case studies demonstrate later in the report.
The year saw a steady growth in client numbers, client contacts and problems dealt with as the number of practices offering the service grew. For example, CAB saw nearly twice as many new clients in quarter 4 as it did in quarter 1. This trend is expected to continue during 2010/11. Experience has shown that CABin general practice can take up to 12 months to achieve its full activity potential.
A notable feature of the statistics is the continued growth of advice and assistance for people with benefit and debt problems. This accounts for over 75% of all enquiries made in the general practice setting. All the indications are that this trend will continue. Other headline outcomes for 2009/10 include:
- 3,490 clients/families helped
- 18,589 problems advised on (average 5 per client)
- £4,545,623 additional income secured
- £7,660,593 debt rescheduled/managed
One in four (27%) clients using the CAB service in general practice receives additional income as a result of that advice, a proportion that has remained constant since the pilot in Hayfield in 1995. The average annual amount of money received in 2009/10 was £4,826 per client/household. A large proportion of this income gain is recurrent because tax credits and welfare benefits continue year on year until the client’s circumstances change.
Behind these figures lay individual stories which statistics are unable to describe. Examples include evictions prevented, disconnections averted, incomes increased, jobs kept, financial disasters alleviated, vulnerable adults and children’s circumstances improved and, on occasion, families kept together. The case studies in the report provide a brief glimpse into the depth and complexity of the stories behind these statistics and their likely impact on health and wellbeing.
Finally, it is important to note that CAB works with clients rather than for them. It is an empowering approach, in which CAB gives clients the tools and confidence to deal with their problems in the future, while helping to resolve their current issues. Lives are changed. A key aim of the service is for clients to leavethe service with their problems resolved and feeling happier and more confident to deal with the world in the future. The outcomes reported here suggest that this is what happens.
Julie Hirst, Public Health Specialist, NHSDerbyshireCounty
Stephen Minter, on behalf of the six Citizens Advice Bureaux in Derbyshire
Derbyshire Citizens Advice Bureauxin General Practice 2009/2010
Statistics
Headline Statistics
2009/102008/09
Clients seen3,4902,049
Contacts11,6415,725
Problems dealt with18,5898,573
Financial gains£4,545,623 £2,376,300
Debt advised£7,660,593 £2,702,894
Cost per client£187£178
Cost per contact£56£64
Cost per problem dealt with£35£43
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
Q1 / Q2 / Q3 / Q4 / TotalUnique
Clients
109 / 105 / 177 / 244 / 600
82 / 94 / 103 / 162 / 413
78 / 68 / 140 / 198 / 476
80 / 80 / 131 / 111 / 374
47 / 72 / 97 / 149 / 357
164 / 187 / 215 / 252 / 763
75 / 80 / 101 / 104 / 327
47 / 43 / 49 / 54 / 180
682 / 729 / 1,013 / 1,274 / 3,490
* 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
Contact Statistics
Q1 / Q2 / Q3 / Q4 / AnnualTotal
AmberValley / 321 / 412 / 623 / 1,027 / 2,383
Bolsover / 317 / 371 / 324 / 413 / 1,425
Chesterfield / 254 / 240 / 376 / 511 / 1,381
Derbyshire Dales / 140 / 166 / 368 / 335 / 1,009
Erewash / 93 / 158 / 206 / 298 / 755
HighPeak / 445 / 445 / 617 / 764 / 2,271
North East Derbyshire / 278 / 328 / 300 / 324 / 1,230
South Derbyshire / 258 / 352 / 295 / 282 / 1,187
2,106 / 2,472 / 3,109 / 3,954 / 11,641
Where from?
Quarterly Contacts
Enquiry Statistics
Ben / Con / Deb / Edu / Emp / Fin / Hea / Hou / Imm / Leg / Oth / TotalAmberValley / 1559 / 18 / 768 / 7 / 245 / 80 / 53 / 158 / 11 / 74 / 278 / 3251
Bolsover / 1621 / 5 / 909 / 7 / 79 / 84 / 33 / 100 / 0 / 87 / 192 / 3117
Chesterfield / 1336 / 20 / 533 / 13 / 91 / 46 / 51 / 94 / 5 / 28 / 139 / 2356
Derbyshire Dales / 943 / 7 / 406 / 3 / 54 / 27 / 16 / 51 / 1 / 28 / 88 / 1624
Erewash / 797 / 19 / 414 / 1 / 128 / 38 / 13 / 51 / 3 / 56 / 133 / 1653
HighPeak / 1238 / 33 / 504 / 12 / 212 / 40 / 48 / 119 / 9 / 104 / 259 / 2578
North East Derbyshire / 1291 / 22 / 566 / 8 / 126 / 66 / 41 / 65 / 9 / 105 / 169 / 2468
South Derbyshire / 586 / 11 / 691 / 1 / 48 / 42 / 13 / 38 / 0 / 39 / 73 / 1542
9371 / 135 / 4791 / 52 / 983 / 423 / 268 / 676 / 38 / 521 / 1331 / 18589
Financial Outcomes for Clients
Benefit gains £3,614,475
Other gains£930,988
Total financial gains for clients£4,545,463
Amount of debt advised /renegotiated£7,660,593
Cost to PCT
Revenue cost £652,025
Cost per client£187
Cost per client contact£56
Cost per problem £35
Clients/families receiving additional income942
Average financial gain by client/family£4,826
Every £1 invested by PCT secures £6.97and manages £11.75 of debt for clients
Case studies
Case study 1
A practice Health Visitor referred Katie and David to our service after they received an eviction notice for from their letting agents after only 6 months of living in the property due to the Landlord suffering financial difficulty, and as a result selling the property. Katie and David have two young children with a third on the way. They are presently living on a low benefit income after both being made redundant. Katie also suffers from depression and anxiety.
They have been through similar circumstances previously and had to vacate their previous home through no fault of their own. The CAB caseworker assisted David and Katie in securing another property with a social landlord which will give them greater protection and a longer term tenancy agreement.
The house that Katie and David were living in benefited from built in appliances and partial furnishings. We were able to secure £200 financial assistance from Bolsover District Council to assist with the removal costs and also assisted Katie and David in securing a community care grant for £600 to pay for essential items for their home. In addition the CAB caseworker also approached a children charity trust (Glasspool) who kindly provided them with a grant for a fridge / freezer. The caseworker also assisted Katie in gaining both a Sure Start Maternity Grant and Health in Pregnancy Grant.
Benefit Gains:
Financial assistance from council £200
Charitable Trust Fridge Freezer - £250
Community Care Grant of £600
Social Fund Payments of £690
Case study 2
Shane, aged 45, was referred to our service via his GP after a deterioration in his mental health, due to a Child Support Agency debt. Shane has been incapable of work due to orthopaedic illnesses for more than 10 years.
In July 2009 Shane was presented with a letter from the Child Support Agency outlining arrears owed in excess of £46,000 relating to non payment of maintenance for his son from a previous relationship, this was the first correspondence Shane had ever received from the Child Support Agency.
CAB identified that Shane had been receiving a prescribed benefit during the effective dates, and appealed the decision to issue Shane with a liability order and stop any further action.
CAB caseworker contacted Shane’s MP to gain his support, his MP contacted the CSA and requested a full investigation into the case. As a result of the appeal and the MP intervention the CSA conducted a full maintenance assessment using information provided by Shane and CAB Caseworker, which has resulted in a reduction of the total amount of debt to £8600.
Shane lives with his wife and 7 year old son on a low income, the CAB Caseworker has assisted Shane in negotiating affordable repayments of £10 per week to the Child Support Agency.
Debt Written off: £38,000
Case study 3
A GP referred John to our service after he advised him to stop work due to arthritis in most of his joints. John is 58 years old and worked in the construction industry for his whole working life. As a contractor he slept in ‘digs’ and has never had a home of his own as he moved about the country frequently for work. Due to his lifestyle he had no savings and the only possessions he owned were clothes. John now found himself physically unable to work, with no money, no home and no possessions. When he came to us he was temporarily sleeping on his sister’s settee which was not helping his condition.
We assisted John to claim Employment and Support Allowance (ESA) which entitled him to payments of £64.30 per week. We then put John in touch with the Local Authority and due to his age and illness the Local Authority swiftly found him a bungalow to rent. CAB caseworker assisted John to claim housing and council tax benefit (a benefit of £74 per week).
As John now had a property to live in but no belongings and no funds to furnish it the CAB caseworker applied to charities to assist John to furnish the property. John received a delivery of a washing machine and fridge from the Severn Trent Trust Fund and he received a cash grant of £150 from ‘The League of Helping Hand’ which we converted into vouchers so that John could purchase pots, pans, crockery and bedding.
John later returned to our service as he received a letter from Job Centre Plus stating that he is no longer entitled to Employment and Support Allowance as he failed the medical assessment. We submitted an appeal on John’s behalf and prepared him for a Social Security Tribunal Appeal Hearing. At the appeal hearing the CAB caseworker represented John and was able to win him back his Employment and Support Allowance with an additional component of £25.50. This was backdated and John received a lump sum payment of £918.
Benefit Gains:
ESA £64.30 per week
Additional component of ESA £25.50
Housing and council Tax Benefit £74 per week
Lump Sum backdate of £918
Charity Funding £150
+ washing machine and fridge
Case study 4
Steve, aged 35, is a single parent with a child aged 12. He lost his job a couple of years ago and has been on Income Support. He came to the GP surgery asking for help with his bank overdraft - he'd been unable to get any money out of the cashpoint and had nothing at all left to live on. He was clearly struggling, looked very stressed and was unkempt.
Steve's mental health was clearly poor - he was very tearful and rambling. He reported not going out, not answering the phone, not opening letters and keeping his curtains closed all the time.
The first stage of the interview was to ask about his income - it turns out that Steve has been living off his Child Benefit for the last few weeks as he's been unable to access his bank account. His CB is paid into the PO, but his Tax Credits go into the bank - when he gets below his overdraft limit he can get a bit of cash out. This is happening less and less frequently. He's been struggling so much that he's sent his son to stay with his son's mother for a few weeks.
So what about Steve's income for himself? As a single parent he's been on IS, but now that his son is 12, he's no longer entitled to it. It has stopped. Steve remembers receiving letters about this happening and thought he had sorted it out, but he hasn't received any money. Has he phoned up to sort it out and ask why? No, because he's been feeling so depressed that he hasn't been out, he's got no money and only has a mobile with no credit. Actually getting in touch with JC+ is extremely difficult.
I called the JC+ on his behalf - his claim for JobSeekers hadn't been processed properly, partly because his case is unusual - he lives in a rural area and is going to be signing-on by post. There is only one member of JC+ staff dealing with postal signing and he had simply slipped through the net. Having got through to the right person, his JobSeekers Allowance was back in payment within a week.
We could then start work on managing his debt. Over the months of not getting JSA, Steve had built up considerable rent arrears and his landlord had started possession proceedings. When a benefit stops, in this case IS, HB and CTB automatically stop. Rent and council tax arrears can build up very quickly. We did a lot of work negotiating with the landlord, the council, getting benefits back in place and helping him prepare his case for the possession proceedings in court. We also encouraged him to open a new bank account without an overdraft swallowing up his income.
During the course of the various appointments with Steve, it was possible to suggest that he see his GP about his mental health. He took this up and was able to access counselling. With Steve feeling more secure and more able to tackle difficulties, his child was able to move back in with him. For Steve, this was clearly the most important indicator of his improved general health and well-being.
Case Study 5
Client visited GP Outreach as they were at risk of losing their home and needed advice. Client received a re-possession order for mortgage arrears (£2,258.13) from the lender, and the possession hearing was due to take place in 6 days. Client is 25 married, unemployed, wife is 25 and disabled.
After the client lost his job, he contacted the mortgage lender and asked to convert from capital to interest only repayments. Client believed that this was agreed for the next 2 years. Client is in receipt of Jobseekers Allowance (JSA) and receives payments towards his housing costs, so client believed the mortgage repayments were being covered.
Client did not understand why there could be mortgage arrears, while the DWP has been making payments towards the mortgage directly to the lender.
Bureau contacted the lender and found out the lender had agreed to convert 75% of capital repayments to interest only repayment for 2 years. This meant that client still had to make the 25% of the repayment himself, as client is only entitled to help from the DWP towards the mortgage interest repayments. The amount of the 25% of repayment varied month to month, from £12- £35.
Bureau helped client with applying for the Amber Valley Borough Council Repossession Prevention Fund. Bureau fill in the application form, drew up a financial statement, making sure that client can afford the future capital repayment, and negotiated with the council. One of the eligible criteria for this fund is for the claimant to be able to sustain the future mortgage repayments and it was important that client could show that he could do this. The application was successful. The outstanding mortgage arrears were cleared and the re-possession order was withdrawn.
Client has arranged for the lender to send a monthly bill so that he knows how much he is required to pay each month and when the payment needs to be made by, so that he can be in control of his household budget.
The GP Outreach worker also helped the client to maximise their household income. They had gas and electricity arrears (gas £586 / electricity £194) with the current supplier, British Gas. We assisted the client with an application to the British Gas Trust Fund. This application was successful and the outstanding arrears have been cleared. The client was also advised to contact AVBC’s environment/ energy efficiency department, as the client’s energy bill seemed too high. The client has received a visit from the council and received advice on improving energy efficiency. Bureau also helped client’s wife to apply for Disability Living Allowance (DLA). It is estimated that she will qualify for High Rate Mobility (£49.10/wk) and Middle Rate Care (£47.10/wk). Client and his wife also had a number of non-priority debts, £10,212.48 in total, and bureau has negotiated repayments with the creditors on their behalf (token offers).