Welfare rights services for people disabled with arthritis integrated in primary care and hospital settings: set-up costs and monetary benefits

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Abstract
Objective. To quantify the set-up costs and monetary benefits of a welfare rights service integrated within an NHS service provider, that selects eligible patients using the Health Assessment Questionnaire (HAQ) and offers welfare rights advice to assist in application for Disability Living Allowance and Attendance Allowance. Method. (1) Design: a cost evaluation of a social intervention, screening with the HAQ and welfare rights advice in primary care and hospital settings. (2) Setting: Eight general practices and four hospital rheumatology out-patient departments were selected from four localities in the southwest of England. (3) Participants: Two hundred and sixty-eight eligible patients with arthritis accepted an interview with a welfare rights officer (WRO) from a sample of 1989 service users identified from GPs’ records and hospital out-patient lists. Two hundred and forty two service users expressed an interest in take up of the social intervention. (4) Service users with a HAQ score ≥1.5 were contacted by telephone and offered an appointment with an experienced WRO to help them complete a welfare benefit application form. A ‘micro-costing’ study was undertaken with assessment of monetary benefits received. Results. The indicative set-up costs of similar welfare rights services are £8125 in a GP setting and £9307 per annum in a hospital setting at 2002 prices. Total annual unclaimed Disability Living Allowance/Attendance Allowance granted to successful claimants was £184,382 in the GP setting (n = 84 from 137) and £169,309 in the hospital setting (n = 79 from 131). Conclusions. Welfare rights advice received during a visit to a GP practice or a hospital out-patient department can substantially reduce the level of unclaimed benefit in arthritic populations including the elderly; with mobility and care difficulties. A welfare rights service integrated within a GP practice or hospital that screens people with arthritis using HAQ scores and encourages those with scores ≥1.5 to see a WRO for help with welfare benefit confers monetary benefits for service users that substantially outweigh set-up costs.

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