Hertfordshire County Council: Partnership action to prevent hospital admissions

Hertfordshire’s strategic approach has been to maintain and strengthen the cross-council, cross-service, multi-partner approach that proved effective during COVID-19, and has been refined and built on for cost of living support. Key partners include Citizens Advice, Age UK, the NHS and HertsHelp (a network of local community organisations), along with Hertfordshire’s 10 district and borough councils.

Gary Vaux, Head of the Money Advice Unit (MAU) at Hertfordshire County Council, said both COVID and the cost of living crisis had presented opportunities to work outside of traditional boundaries. This includes working with the voluntary, community, faith and social enterprise sector (VCFSE) and across council services. Cost of living activity is overseen by a steering group which includes all the key organisations, and by a stakeholders group which is broader.

Hertfordshire was one of the first places to have an integrated care system (ICS), with Hertfordshire and West Essex ICS set up in 2020. A recent proposal for £1 million ‘cost of living’ funding was approved by the ICS, in conjunction with Hertfordshire County Council and some of the financial services that the council commissions.

A key aim of this one-year funding is to prevent costly hospital admissions and crisis service interventions, given the well-evidenced link between deprivation and poor physical/mental health. It will be used to increase the capacity of specialist advisers in the council’s MAU, Citizens Advice, HertsHelp and the voluntary sector to identify people who would otherwise reach crisis as a direct result of financial pressure, fuel poverty and cold homes.

• Citizens Advice will provide additional advice around debt, income maximisation and other support available.
• The MAU will help residents whose needs are more complex, such as people with a disability, long-term health condition or mental health issues. This will be done through a small team of 2.5 advisers and a part-time manager, located in the enhanced primary care team, working to resolve benefit problems before they reach crisis point.
• HertsHelp will help people to access crisis support such as emergency payments for food, fuel and white goods while they are referred onto longer-term support pathways.
• Age UK Herts will support residents through its winter welfare checks, which provide a gardening and ‘handyperson’ service that can help with insulation and undertake practical tasks to remove trip hazards and prevent falls.

Gary Vaux said: “It’s a good example of integration. If we keep one person out of hospital for six months, that’s a huge saving to the NHS. Do that for four people and the project pays for itself.

“After a year we hope to demonstrate results not just in the amount of benefit gained but, more importantly, in what it means to that individual – what difference has it made to their ability to cope. If we can address people’s financial problems we can help to address anxiety, depression and crisis.”

Councillor Richard Roberts, Leader of Hertfordshire Council, said:

“Our commitment is to help those people who need it the most. This work demonstrates the council’s corporate plan priorities in action, and is a good example of what close collaboration focused on individuals and communities can deliver. I anticipate more achievements of this nature with the members of the Integrated Care Partnership across Hertfordshire and West Essex.”

Support providers across Hertfordshire report a huge increase in demand, particularly since summer 2022. As just one example, the MAU works in partnership with Macmillan, taking referrals for people affected by cancer. Until April 2022 there were around 100 referrals per month. The average for July to December was 155, representing a consistent monthly rise.

Hertfordshire County Council has used behavioural science research to develop an awareness-raising communications campaign, ‘Here for you this winter’. The council’s behaviour change unit has set out its recommendations for other local authorities in a research paper.

Gary Vaux said the MAU was now looking at how to encourage people to actively seek support. One example is the number of disabled older people who could apply for attendance allowance but assume they would not be eligible. “It’s about trying to convince people to take that next step of moving from knowledge to action – that’s where we have to go next.”

• Cross-party political support has been important in moving things forward quickly.
• It is early days, but those involved welcome the opportunity to work together to explore new ways of meeting the needs of communities in these difficult times.
• Restrictions on the Household Support Fund, such as not being able to spend it on advice provision, have limited its potential to address need.
• The council and advice partners are finding it difficult to recruit benefit advisers – partly because most posts are only funded for one or two years.