Title: Evaluating the health impact and cost-effectiveness of Ways-to-Wellbeing, a whole system approach to mitigate poverty over the life course.
Funder: Department of Health and Social Care

Abstract: Background: Individuals who face financial difficulties are at risk of poor health, this contributes to the stark inequalities in health between social groups in the UK. Risks of poverty are increasing during the current crisis, potentially exacerbating inequalities. The health and social care system is seeking to integrate anti-poverty measures into services to reduce health inequalities, however there is insufficient evidence to indicate the most effective approaches Intervention: The Ways-to-Wellbeing (W2W) intervention in Liverpool provides advice and support to reduce financial insecurity to people using a wide range of health services (antenatal care, health visiting, primary care and A&E). Objectives: To quantify the health and health economic impacts of different components of W2W when implemented in different parts of the health system and whether effects differ between different socioeconomic and demographic groups. To understand how these different groups of participants experience the W2W intervention, and the mechanisms through which it has or has not influenced their health and wellbeing. To estimate the cost-effectiveness of the intervention under alternative implementation assumptions and explore the public value and fiscal benefits generated. To produce recommendations for action by engaging stakeholders and members of the public in synthesising findings in order to identify the characteristics of the intervention that are most likely to reduce health inequalities, as well as practical advice on development, delivery and implementation. Methods: We combine three approaches to achieve these objectives. Firstly we estimate the impact of the W2W on consultations for Common Mental Disorders, by using propensity scores to match households receiving the intervention with comparison households that have similar characteristics but have not implemented a CWI. We will then apply difference-in-differences analysis to compare changes in this outcome in the intervention group before and after the intervention with changes in the outcome in the comparison group. We will use similar methods to assess the impact of the W2W on child health outcomes and hospital admissions. Secondly we use qualitative interviews to understand the mechanisms through which the intervention has influenced outcomes. Finally we will assess the costs and benefits of the intervention to indicate whether the intervention represents value for money compared to other public health interventions. Timeline for Delivery: The research will be delivered between April 2021 and March 2024. Anticipated impact: The research will indicate the critical components needed for implementing W2W and the likely costs and benefits of these approaches. We will work with health and social care services across the UK, to implement these findings in integrating poverty mitigation support into health services that is likely to improve health and reduce health inequalities.

Lay abstract: Financial difficulties can lead to poor health. This contributes to the large differences in health between people with low incomes compared to those with higher incomes. In recent years people have experienced increasing financial difficulties due to the effect of the COVID19 pandemic on the economy. Problems with debt and low income are leading to mental health problems. Health services, can help people manage these financial problems better. For example in Liverpool they have been working with the charity Citizens Advice, to provide people using health services with financial advice and support. This service, called Ways-to-Wellbeing is expected to see around 30,000 people by the end of 2022. Many NHS organisations are investing in similar initiatives, however we do not know whether they lead to improvements in health or whether they are good value for money to the NHS. This research project will work out whether the Ways-to-Wellbeing service has improved people s health and which parts of the programme worked best. We will compare the cost of achieving any benefits to other activities the NHS could spend its money on. Using data from health services and Citizens Advice we will identify people who have used the Ways-to-Wellbeing service and a group of people with similar characteristics who have not used this support. We will then compare how the health of adults, and their children changes in these two groups, before and after the intervention. As the number of people receiving the intervention is expected to be very large, we will be able to understand, whether it is more or less effective for some patient groups compared to others. We will also interview people using the service to understand how their experience of it has influenced their health and wellbeing. Working with service users, other members of the public, charities and NHS organisations across the country, we will use the findings to make recommendations about how to introduce similar services in other parts of the country.

Research activity codes: 8.2 HEALTH AND WELFARE ECONOMICS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE;MENTAL HEALTH