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The role of the Citizens Advice Bureau in supporting health care.

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VOL: 100, ISSUE: 36, PAGE NO: 26

Ian Brown, is press and communications officer, Citizens Advice Scotland (CAS), the umbrella body for the 77 Citizens Advice Bureau offices in Scotland.

Scotland's 77 Citizens Advice Bureau (CAB) offices will hold their annual awareness week, Advice Week, on 6-12 September, to highlight the vital role they play in communities and to encourage more people to volunteer to get involved in the service. Ninety per cent of CAB workers are trained volunteers, but because people move on - often thanks to the training and experience they gain within a bureau - the service always needs more people.

Scotland's 77 Citizens Advice Bureau (CAB) offices will hold their annual awareness week, Advice Week, on 6-12 September, to highlight the vital role they play in communities and to encourage more people to volunteer to get involved in the service. Ninety per cent of CAB workers are trained volunteers, but because people move on - often thanks to the training and experience they gain within a bureau - the service always needs more people.

The role of the CAB
CABs are charitable organisations, mainly staffed by trained volunteers who dispense free and impartial advice and information to the public on a wide range of issues. However, the main issues that clients bring up concern consumer debt, welfare benefits, and employment rights (Citizens Advice Scotland, 2003).

Computer-based information and retrieval systems have allowed CAB advisers to take advice beyond the high street and into a range of settings within the community. The CAB's 12,000-page information system is now compressed onto a single CD-ROM, thereby enabling advisers to operate anywhere a laptop computer can be plugged in.

CAB and health care
With people's social and financial circumstances now recognised as a factor - even a cause - of physical or mental ill-health, more and more CABs now offer an advice outreach service in health care settings, including hospitals and GP surgeries.

The range of CAB advice given in health care settings has expanded rapidly over the past few years. For example, the CABs in Dumfries and Galloway, Lanarkshire and the Highlands have teamed up with Macmillan Cancer Relief to offer a dedicated service to people with cancer and their families. CABs in Motherwell and Wishaw, and Stirling, help clients with mental health problems. Raigmore Hospital in Inverness, the largest hospital in the Highlands, has had its own onsite CAB office since 2003.

Good advice can make a significant difference in helping to maximise the quality of someone's life and relieving stress. Nurses know there is not much point telling people to concentrate on getting well if they are worried that they cannot cope financially or may lose their job.

People affected by severe injury or sudden illness often need advice on issues such as sickness and disability benefits, how to manage debts and mortgages if they are no longer working, and employment rights. When people come to hospital with a severe illness their whole support system can fall apart. It is seldom a single issue that patients have concerns about - there are often several, including statutory sick pay, housing costs, employment rights and carers' allowance. CAB advisers often get enquiries from people with no previous experience of benefits, who do not know their way around the welfare system and can find the benefit rules governing hospital stays extremely complex.

The Acheson Report (Department of Health, 1998) found that those who experience deprivation have poorer health, die at a younger age and make more demands on health services. Academic research, commissioned by CAS to evaluate its members' work in health settings, has endorsed this. One report by Aberdeen University noted: 'Many problems presenting themselves to primary care are wholly or partly social in nature. Addressing the social issues relieves demand on health services, both directly and indirectly' (Aberdeen University Department of Management Studies, 2001).

Issues that patients need help with
The questions people ask CAB advisers usually relate to issues they have never had to think about before, such as: 'What benefits am I entitled to if I'm ill?'; 'What happens about my debts and my mortgage if I can't work or have to go into hospital?'; 'Who will care for my children?'; or 'Can my employer sack me if I'm off work for several months?'

Queries from health care staff tend to be more diverse. The Raigmore Hospital CAB has been asked about lost luggage, accommodation and employment disputes, and - commonly - relationship issues.

Many patients have gained financially thanks to CAB intervention. Peebles CAB in the Scottish Borders managed to get a £500 debt written off for one client who was almost suicidal with depression.

Castlemilk CAB in north-west Glasgow has already won £735,000, mainly in patients' unclaimed benefits, since its inception last year. Raigmore Hospital CAB even arranged for an injured female hill-walker to be flown back home to Essex free of charge.

Comments from clients
- 'I didn't know anything at all about disability living allowance. If it hadn't been for the CAB, I never would have applied for it.'

- 'It's given me some peace of mind during a time when my life's been turned upside down.'

- 'It's made a lot of difference [receiving disability living allowance], a huge difference - it's eased the financial pressure greatly. I've had extra costs due to the illness because I've had to travel up and down to London for treatment. That was a financial drain.'

- 'It was just excellent to have someone come to the house and sort these things out for us. I don't know whether I'm coming or going with running up and down to the hospital. I couldn't have done that on my own.'

Reducing the burden on staff
As well as directly helping patients, the CAB is also benefiting hard-pressed frontline health care staff. Most health practitioners have not got time to become experts in welfare benefits, housing rights or debt counselling. This is the 'health gap' that CAB is working to fill in order that health care staff can concentrate on their patients' health, while CABs help improve their circumstances.

Teresa Rennie, lead cancer nurse for Lanarkshire, explains: 'The advice service has had a tremendous impact on our daily work. It has relieved us from dealing with financial assessment, housing issues and completing benefit applications.

'We are now able to concentrate more on our clinical work. And it has also allowed individuals who are in our care to worry less about the financial implications that are associated with a cancer diagnosis. It gives them more peace of mind and enables them to focus on participating in their care.'

The future
The CAB service in Scotland is looking to expand its work in health care settings. It is in negotiations with the Scottish Executive's health department to draw up a formal framework through which CABs in each of Scotland's 15 health board areas might offer a comprehensive advice service to patients and staff. This could open up a whole new dimension to CAB work, and see CABs become as familiar in health care settings as they are on the high street.

It is now hoped that the CAB service in Scotland will be acknowledged as the missing piece of the health care jigsaw. There is also a need for more people to volunteer to be advisers.

No formal experience or qualifications are needed as full training and support is given, but volunteers will usually have to commit to a minimum of four or five hours a week.

This article has been double-blind peer-reviewed.

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