Guidance

Financial wellbeing: applying All Our Health

Published 8 November 2022

© Crown copyright 2022

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.

Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

This publication is available at https://www.gov.uk/government/publications/financial-wellbeing-applying-all-our-health/financial-wellbeing-applying-all-our-health

Introduction

This guide is part of All Our Health, a resource that helps health and care professionals prevent ill health and promote wellbeing as part of their everyday practice. The information below will help frontline health and care staff use their trusted relationships with patients, families and communities to promote the benefits of financial wellbeing.

We also recommend important actions that managers and staff holding strategic roles can take.

The importance of promoting financial wellbeing in your professional practice

We all have to make decisions about money every day and throughout our lifetimes – small decisions such as which loaf of bread to buy through to bigger decisions around housing, debts, investments, powers of attorney and making a will.

The Money and Pensions Service defines financial wellbeing as feeling secure and in control of your finances, both now and in the future. It’s knowing that you can pay the bills today, can deal with the unexpected, and are on track for a healthy financial future.

However, there is a lot of evidence to show that money and health are intertwined. Health and care professionals meet people every day who are living in poverty or struggling with their finances. In this sense they are in a unique position to guide people to the right support. Asking someone about their financial wellbeing could not only positively impact on that person’s everyday life, but also their health.

Life expectancy is one of the main measures of health inequality and is closely related to socio-economic status. This systematic relationship between deprivation and life expectancy is known as the social gradient of health.

Core20PLUS5, NHS England’s approach to support the reduction of healthcare inequalities at both a national and system level, provides a focus on target population groups who are likely to experience health inequalities. It includes the most deprived 20% of the national population as identified by the Index of Multiple Deprivation (IMD).

In 2020 to 2021, around 9.5 million people were living in poverty in the UK. If you live in a deprived area you can expect to live on average for around 8 years less than someone in an affluent area. Your chances of acquiring a health condition earlier in life, and therefore having to live with that condition for longer, also increases.

Evidence shows that certain groups of people may be more likely to be living in poverty than others.

There is also a higher likelihood of living in poverty if someone is renting compared with someone who owns their home or has a mortgage.

In 2020 to 2021 there were 3.9 million children living in poverty in the UK. Living in poverty impacts a child’s whole life, affecting their education, housing and social environment and in turn impacting their health outcomes and their social, emotional and cognitive development.

For example, if a parent is not able to afford healthy food for their child, this can lead to poor growth in some cases and obesity in others. Not being able to afford quality housing that is free from damp, or not being able to afford to keep the home warm can make respiratory problems worse.

If parents are living on a low income, being able to afford to pay for transport to get to doctors appointments, school and other activities is very difficult. This means that the child may miss out on getting treatment, education and social activities.

People who are living in poverty are often charged more for essential services, such as having to have a pre-payment meter for gas and electricity or being asked to pay more if they cannot pay a bill by direct debit. This is sometimes referred to as the ‘poverty premium’.

Almost 1 in 5 people living with a mental health condition will have problem debt and almost half of people in problem debt will have a mental health condition. The symptoms of some mental health conditions can make managing and making decisions about money more difficult.

For example, if someone lives with bipolar disorder they may lack impulse control during manic periods and overspend. Living with debt is very stressful: people are often frightened that they may lose their home or have bailiffs knocking on their door. This ongoing stress can impact on mental health.

More than half of people who experienced mental ill health in the last 3 years report that thinking about money makes them anxious. Some 44% are behind on a priority bill and 32% say they often borrow to buy food or pay bills because they’ve run out of money.

More than 90,000 people die every year in the UK in poverty with 1 in 4 terminally ill people of working age spending the last year of their lives in poverty.

Other research also indicates that money can impact our wellbeing in 4 ways:

1. Material

Money buys goods and services that improve health. The more money people have, the better the goods they can buy.

For example, if someone is struggling to cover all of their essential bills from their income, they have very little money left over for buying healthy food or paying for activities that may improve their health, like taking part in physical activities.

2. Psychosocial

Managing on a low income is stressful. Comparing oneself to others and feeling at the bottom of the social ladder can be distressing, which can lead to biochemical changes in the body, eventually causing ill health.

3. Behavioural

For various reasons, people on low incomes are more likely to adopt unhealthy behaviours – smoking and drinking, for example.

4. Reverse causation (poor health leads to low income)

Poor health may affect income by preventing people from taking paid employment. Childhood ill health may also affect educational outcomes, limiting job opportunities and potential earnings.

Maximising income

Being able to increase your income is one way to improve financial health and in turn take steps to reducing the negative impact that low income and poverty have on health.

Sometimes people are entitled to welfare benefits that they are not currently receiving, such as:

  • Personal Independence Payment
  • Universal Credit
  • Pension Credit
  • Carer’s Allowance

Financial support from a local authority might also be available, such as:

  • Council Tax discount, exemption or support
  • Discretionary Housing Payments

As a health and care professional, you are not expected to be an expert in welfare benefits and other ways a person can maximise their income. But having an awareness that this can impact on financial wellbeing and knowing where to suggest people can go for support is key.

People can try to find out which welfare benefits they may be entitled to via a number of online tools, such as:

Paid employment is another way that people can increase their income and in turn improve their health. As well as the financial benefits of work, the social elements have also been shown to be good for wellbeing.

This learning module does not cover work and employment specifically. But if you are working with someone whose health and financial worries are related to work (for example, if they need support getting a job, if they have a job but are off-sick and would like to return to work, or if they are experiencing issues at work that are impacting on their health) then there are services and support you can make them aware of, such as:

Looking after your own financial wellbeing

As health and care professionals, your focus at work is on looking after others. However, there are times when you may need support in relation to your own wellbeing, including your financial wellbeing. Therefore, all of the guidance in this resource can be just as helpful for you as for the people you are supporting.

If you do have concerns about your finances, whether in relation to meeting your costs day to day, paying off debts, or decisions about your pension, you can get free, independent information and guidance from the government-backed MoneyHelper service.

Depending on your profession you may be able to access financial support through your professional body. Trade unions also offer a range of support services should you need them. You can search for all grant giving organisations via Turn2us.

If you’re a manager, be aware that your staff may be struggling with their own finances, too. Offer to talk about this sensitively in your catch-ups with them. Signpost to any support your organisation provides (such as NHS Employers or an employee assistance programme).

If you hold a senior or strategic position, can you ensure financial wellbeing is included alongside physical and mental wellbeing support for your employees? You can get information and resources about financial wellbeing in the workplace from the Money and Pensions Service.

What you can do to help

Core principles for health and care professionals

This ‘All Our Health’ financial wellbeing information has been created to help all health and care professionals:

  • understand specific activities and interventions that can improve financial wellbeing and subsequently impact on health
  • understand the important difference between providing guidance to someone about their money situation and providing advice
  • think about the resources and services available in your area that can help people understand, manage and improve their financial wellbeing

Taking action

Money guidance versus money advice

Be aware of the difference between money guidance and money advice and do not fall into the trap of giving any advice. Providing advice about financial matters, including debt, is an activity that is regulated by the Financial Conduct Authority, so only properly trained and insured individuals and organisations can provide it.

‘Advice’ in this context is defined as recommending what a person should do about their finances and debts and/or recommending a particular financial product, such as a bank account, credit card, loan or insurance policy.

If you’re a frontline health and care professional

You should:

  • take time to reflect on how someone’s financial situation could affect all aspects of their everyday lives and the impact on their physical and mental health

  • ask about the person you’re supporting’s financial wellbeing and if they have any money worries as standard. Normalising the conversation about money, and showing you’re not embarrassed to talk about it, can help reduce the shame and embarrassment people can feel when talking about money

    • time constraints may mean you cannot ask during every interaction. But if you have concerns that someone’s financial situation is impacting on their physical and mental health, try to weave it in

    • you could use the ‘very brief intervention’ model to help have the conversation

Very brief intervention: ask, assist, act

Ask: you could start the conversation by saying something like: “Is it ok to ask you about your money and finances?”

Assist: if the person agrees, you could say: “Can I share with you some information about free services that provide impartial advice on money – everything from welfare benefits, budgeting, debt, borrowing and pensions?”

Act: signpost or refer the person you’re supporting who has money worries to free, impartial and trusted sources of support, such as the government-backed MoneyHelper service. This is available online, over the telephone and on WhatsApp, with resources available in large print and Braille, if required. There are more suggestions for support in the ‘Further reading, resources and good practice’ section below.

Be aware that money is a sensitive subject, and different cultures may have different views and feelings about it. If you’re supporting someone whose first language is not English, they may want an interpreter (and one from outside of the local area, if possible, to avoid it being someone they might know) so they feel more comfortable talking about it and to ensure that any words or concepts about money do not get confused.

There may be times when you are supporting someone who you think does not have capacity to make decisions about their finances. Refer back to your local policies, procedures and guidance on what to do in this situation. Make sure you are compliant with the Mental Capacity Act 2005 and accompanying code of practice in relation to property and financial decisions.

If you are concerned that the person you are supporting is a victim of or at risk of financial abuse and/or if their financial situation is resulting in neglect then follow your organisation’s safeguarding policies.

Join the Money Guiders Network to share experiences of providing money guidance with your peers, and keep your knowledge about relevant money topics up-to-date.

If you’re a team leader or manager

You should:

  • promote the importance of addressing financial wellbeing alongside physical, emotional and mental wellbeing to your staff team. Share with them the statistics and stories showing the relationship between money and health, and stress the importance of asking about money as a way of tackling health inequalities related to poverty

  • find out if you have any free and impartial money guidance and advice services in your local area. Find out what kind of issues they can support with and let your team know they can signpost patients to relevant services. Flag the services that are also available to people who may be homeless, refugees, from the Traveller community or may not be ‘local’ for other reasons but still need financial support

  • encourage recording of money-related issues and where signposting to money advice services has taken place as a way of evidencing steps taken to tackle health inequalities

  • ensure relevant policies and procedures used by your team reflect how they should deal with money-related issues. For example, does your safeguarding policy cover financial abuse? Do you have a policy on which money advice organisations your staff should signpost people to?

  • ensure that members of your team are working within safe boundaries in relation to providing money guidance and that they know they must not stray in to providing advice. You can use the Money Guidance Competency Framework to review the money guidance your team provides and identify any areas for development

  • provide opportunities for ongoing learning by encouraging staff to attend Money Guider Network events and other locally provided training and learning sessions

If you’re a senior or strategic leader

You should:

  • conduct a mapping exercise of the roles within your department or organisation and decide what level of money guidance you would expect each role holder to provide. You can use the Money Guidance Competency Framework for support with this

  • ensure learning opportunities are made available to relevant staff so that their knowledge and skills related to providing money guidance are up-to-date and they can deliver guidance in a safe and boundaried way

  • utilise data about the level of need for money advice in your area and feed this into relevant planning decisions, such as joint strategic needs assessments

Understanding local needs

Fingertips, OHID’s public health data collection, allows you to find data related to the wider determinants of health by local area.

The Healthcare Inequalities Improvement Dashboard can be accessed by regions, systems, primary care networks, NHS providers and local authorities to see their own local data. The dashboard measures, monitors and informs actionable insight to make improvements to narrow health inequalities.

The ‘poverty premium’ is the extra costs people on low incomes and in poverty pay for essential products and services. This can include:

  • having to use a pre-payment meter for electricity or gas
  • paying to access cash
  • using high-cost credit

This interactive map by Fair by Design allows you to check how much the poverty premium costs individuals in your geographic area.

This report from the Money and Pensions Service shows the trends around need for debt advice across the UK, broken down in to regional data.

This database allows you to view up-to-date data on a range of topics, including money related, that Citizens Advice collects, broken down by region.

This Local Government Association dashboard allows you to view the financial hardship and economic vulnerability data as a result of COVID-19 within your local authority.

This map from End Child Poverty allows you to see child poverty levels at a constituency level.

Measuring impact

As a health and care professional there are a range of reasons why it makes sense to measure your impact and demonstrate the value of your contribution. This could be about sharing what has worked well to benefit your colleagues and local people, or help you with your professional development.

The Everyday Interactions measuring impact toolkit provides a quick, straightforward and easy way for health and care professionals to record and measure their public health impact in a uniform and comparable way.

Utilise a logic model approach to measuring money-related interactions. This could include recording what you did, what happened as a result and what the outcome was. For example:

  • you have a conversation about money after noticing a person’s home was cold and seeing evidence of unopened bills on the sideboard
  • you signpost to a local advice service
  • the person agrees to seek money guidance and advice from a local advice agency
  • the agency provides advice on additional welfare benefits the person is entitled to and supports with debt advice
  • the person’s income now increases and their debts are resolved
  • they receive budgeting support so they are now able to heat their home and keep warm

If you put on a learning session for your staff, ensure any evaluation of it captures the difference the learning has made to both staff and the people they’re supporting.

Further reading, resources and good practice

Advice for patients and the public

Professional resources and tools

Good practice examples

There are a number of social prescribing services that are bridging the gap between health and money by ensuring that their link workers are able to ask about money and get people to the right advice and support for their financial issues.

Examples include:

There are also partnerships between the NHS and money advice services for people with specific health conditions. One example is the partnership between Auriga, some NHS trusts and Kidney Care UK for people living with kidney problems. You can read an example of how a nurse identified that money issues could be a problem for one of their patients and the positive impact of making a referral to advice.

Back to top