Citizens Advice in the hospice

Project overview

The Myton Hospices wanted to support people who are experiencing financial challenges alongside coping with a palliative or end of life diagnosis. 

Working in partnership with Coventry Citizens Advice, the hospice set up a one year pilot project to embed an advisor into the hospice team. This is partly funded by Myton and partly by MacMillan Cancer Support.

Outcomes

The advisor works across inpatient and outpatient services, and attends Multi-Disciplinary Team (MDT) meetings. He is a valued member of the team and is able to make and receive referrals through the MDT. In a relatively short time, the advice service has become established as part of Myton’s offer to patients and families. 

The advisor is able to support patients and families with a range of issues before or after someone has died, including:

• registering a person’s death via the Tell Us Once service 
• probate issues
• making a will
• funeral planning (including how to cover costs)
• applying for financial support, grants and benefits (some of which can be backdated)
• ensuring a partner will be able to afford rent payments after someone dies
• debt management
• fuel poverty
• food poverty
• putting utility accounts into two names to make it easier when the main account holder dies
• transport and fuel costs
• adaptations and equipment for the home.

The advisor fills in any forms on people’s behalf, so they don’t have to worry about paperwork during an already challenging time.

The aim of the service is to build a positive relationship with patients and families at an early stage, helping them access the support they need as their journey progresses. This reduces stress and allows people to focus on what is most important to them. 

Key facilitators

Myton has wanted to offer a service like this for a long time, but was not able to deliver it alone. Working in partnership with Citizen’s Advice (CA) with funding from MacMillan Cancer Care has been invaluable. 

Coventry CA only covers a small part of the hospice’s geographical footprint. The CAs in Rugby and Warwick have given permission for the embedded CA advisor to work all over the hospice’s patch. This means all of Myton’s patients and families can access the service. MacMillan has also allowed the service to be extended to patients with non-cancer conditions.

The hospice and the CA have similar values, which has given them a strong foundation for partnership working. Both sides have worked hard to understand each other’s ways of working. Before the service launched for patients, there was a month where the CA advisor worked in the hospice, building relationships and developing processes. 

The hospice has a friendly and supportive culture, which has helped the CA advisor feel welcome. 

Providing advice about the issues that affect people at the end of life is complex and requires a high level of skill. The advisor that is placed in the hospice is a senior member of staff with a wealth of knowledge and experience. His contribution is valued by the hospice team.

Challenges

Both organisations have been on a learning curve since the partnership started. The advisor is based at the hospice but managed by Citizens Advice. However it’s important that the hospice still provides supervision and support.

As the project is relatively new, patients and families have sometimes been referred for advice at a late stage in their journey. This can mean the advisor is working with families after a patient has died. Ideally he would be involved much earlier in the family’s journey and as the service becomes more established it is hoped relationships will be established earlier.

Some people might be reluctant to access benefits. This might be because of stigma, or because they don’t think they are entitled to anything. The team overcome this by building up relationships with families and explaining what support is available. The more visible the advisor is, the more people access the service.

Myton has three hospice sites and it can be challenging for one individual to work across a wide geographical area. The team are monitoring this by mapping demand and capacity for the service. 

The team is gathering evidence to show how the service is being used and highlight where there is still unmet need. This will support applications for more funding to extend the project. Depending on the need, the project could continue with one advisor, or employ more advisors. 

The hospice is working with the CA Advisor to identify ways to improve referral pathways. This includes encouraging earlier referrals so that the advisor can work with clients earlier in their journey.

A key part of streamlining the service will involve giving the CA advisor access to the hospice’s electronic records. This will help promote information sharing between the advisor and Myton staff, and give patients more continuity of service. This will include putting data sharing protocols in place.

Image: courtesy of In-Press Photography via The Centre for Ageing Better.