23/84 Health and health inequality impacts of voucher and benefit uptake

Research Question:

• What interventions are effective in increasing uptake of welfare benefits and vouchers for groups who are entitled to this support?

The positive relationship between health status and access to sufficient financial resources is well established. Therefore, increasing the uptake of welfare benefits and other financial support schemes, such as vouchers, has the potential to improve health outcomes through an increase in income and reduction in health inequalities.

Many people on low incomes who need (and want) financial help receive less than the system intends, i.e. less than the full extent of that to which they are entitled. Historically, in the UK, there has been substantial underclaiming of welfare benefits and vouchers. It is estimated that every year, there are several thousand people who miss out on welfare benefits, vouchers, and help from one-off or time-limited financial support schemes. Underclaiming of such entitlements totals billions of pounds. Support schemes including the Energy Bills Support Scheme, Healthy Start and Tax-Free Childcare, and welfare benefits including Attendance Allowance, Child Benefit, Pension Credit and Universal Credit are all known to be underclaimed, particularly by people from ethnic minority backgrounds.

Welfare benefit and voucher uptake can be affected by multiple factors. Messaging and the process for applying can be complex and difficult to understand. The processes for applying are not always accessible for different population sub-groups. For example, digital or paper-only application systems might (unintentionally) exclude some population groups. Poor uptake may also be influenced by the stigma that some people might feel about claiming welfare benefits.

To improve uptake, welfare advice services are offered by local government departments and by the voluntary, community and social enterprise (VCSE) sector. Some welfare advice services operate in health and social care settings to increase visibility and accessibility. A recent systematic review was able to show that co-located services were effective and there was some limited evidence showing benefits to health. Recommendations have been made for more high-quality research on interventions that target under-served groups and research that includes economic evaluations.

Obtaining official, reliable, and up-to-date data on the prevalence and extent of underclaiming can be challenging. Responsibility for the administration of various welfare benefits and other support schemes can often change within and between different areas of government.

The Public Health Research (PHR) Programme is predominantly interested in interventions operating at a population/group level rather than at an individual level, and which should address health inequalities and the wider determinants of health. The PHR Programme recognises that interventions are likely to impact different (sub)populations in different ways and encourages researchers to explore such inequalities of impact in their study design.

Of particular importance to the PHR Programme is an understanding of inequalities in impact of policy and access to services by people from ethnic minority backgrounds in the UK. Evaluations of interventions seeking to reduce health inequalities experienced by people from ethnic minority backgrounds are also of specific interest to the PHR Programme.

Suggested areas of research could include but are not limited to:

• What are the effective ways of reaching an under-served group, removing barriers and facilitating uptake of welfare benefits, vouchers, and support schemes?
• What interventions are effective in supporting people with lower levels of literacy?
• How does co-locating welfare advice services affect uptake and how does this impact health? Examples of co-located services could include interventions in health services, education, or community settings.
• What are effective ways of supporting uptake of welfare benefits and vouchers for people living in specific geographies such as rural areas?
• How should messages regarding uptake be tailored and delivered to raise awareness of, and encourage and sustain uptake in different population groups?
• What interventions are effective in reducing negative perceptions and stigma regarding claiming welfare benefits? This could include interventions focused on tackling certain upstream drivers such as media influence on social norms and discourse.
• Which elements of community-based or a community-led interventions work best for which populations? How and when should the interventions be delivered, by whom, and in what contexts?
• How can local government and the VCSE sector work together to improve access to, and increase uptake of, welfare benefits and vouchers?
• Which interventions improve the availability of data on welfare benefit and voucher uptake, and what is the impact on uptake?

The PHR Programme acknowledges that in response to this funding opportunity, some interventions might be jointly- or fully-funded by the NHS, but delivered by non-NHS organisations. If a robust argument can be made for the generalisability of the research to non-NHS settings, an evaluation of the intervention might be in remit for the PHR Programme. Please contact the PHR Programme before applying to discuss further.

The PHR Programme recognises that for some proposals, underpinning or development work to understand epidemiology and inform the evaluation of interventions might be beneficial. The Programme is willing to consider applications that include a maximum six-month period of underpinning or development work. Please contact the PHR Programme before applying to discuss further.

A range of study designs and outcome measures can be used. Researchers will need to clearly describe and justify their choice of welfare benefit(s), voucher(s), and/or support scheme(s), outcomes, and target population group, as well as the rationale for their methodological approach. Researchers will need to specify how outcomes will be measured in the short, medium and long term. The PHR Programme typically requires primary outcomes to be direct health outcomes. However, given the focus of this commissioned call and the research question posed, the Programme will accept proxy measures for health – in particular, uptake of welfare benefits, appropriately defined – as long as the link to health is clearly justified. Researchers are encouraged to consider additional outcome measures including those relating to the broader determinants of health and health inequalities, which should be specified and justified.

Understanding the value of public health interventions – whether outcomes justify their use of resources – is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include an economic component should provide appropriate justification.

Researchers are strongly encouraged to ensure that there is involvement from people with lived experience and other relevant key stakeholders in the design of the intervention and the evaluation. Researchers can do this by involving them as costed members of the research team. Researchers are encouraged to explain how they will share their findings with local and regional governments, health and social care organisations and agencies, policy makers, special interest organisations, charities, community audiences and other relevant stakeholders. Researchers are expected to be aware of other studies in this area and ensure their proposed research is complementary.

For further information on submitting an application to the PHR Programme, please refer to the Stage 1 guidance notes and PHR supporting information. These can be found by clicking on the relevant commissioned call on the main call page. This also includes closing dates and details about how to apply.