As money worries plague more and more patients, nurses are being offered new training on how to help people suffering from financial stress-related conditions.
According to a new survey, more than half (57%) of nurses say they have seen an increase in the number of patients presenting with conditions potentially caused or made worse by worries about money in the last six months.
“We’ve always been rooted in the idea of a health service free at the point of access, and so anything to do with finance, we’ve always been a bit unsure of”
Rachael Hebbert
Three quarters of the 180 nurses who answered the survey felt supporting patients with money problems could prevent further health problems in the future.
However, 89% felt unequipped to have conversations with patient about money out of fear of not knowing what to say, feeling it is not their place, or of not knowing the answers.
The majority, 77%, told the survey they would like training on how to broach the topic of money struggles with patients.
The research has been undertaken by the Personalised Care Institute (PCI) and government-sponsored help organisation the Money and Pensions Service (MaPS).
Rachael Hebbert, associate chief nursing officer at Wye Valley NHS Trust and PCI ambassador, who is also a Queen’s nurse, spoke of a “previous inability” to help and signpost people struggling financially.
Ms Hebbert, who has worked in nursing for 30 years, mostly in the community, explained that frequently she would meet a patient for a physical ailment – like a wound – and notice that there could be something else wrong, but struggle to find the words to help.
“We’ve always looked at patients and people holistically,” Ms Hebbert told Nursing Times.
“But we’ve always been rooted in the idea of a health service free at the point of access, and so anything to do with finance, we’ve always been a bit unsure of.
“Our services are free, and [money is] not something which comes to mind.”
She said that, with the cost of living crisis and Covid-19, however, finance was now something a nurse could not ignore.
In particular, Ms Hebbert said she had seen more older patients than ever before presenting with issues which have been exacerbated by money worries: “It’s across the age range, but that is the demographic I have experience with – older, frail patients.
“The impact of social isolation on them [is huge]. After Covid, there might be activities they can go to, but they cost money – it’s transport, that costs.
“And then for everyone, there is the cost of healthy foods which are invariably more expensive than unhealthy ones.
“Then this has a direct impact on health and would healing. And you see the rise of unhealthy behaviours which cost money, but people make those choices – like alcohol, smoking. “
Ms Hebbert said nurses sometimes felt “helpless” when they, for example, spot a pile of unopened envelopes in a patients’ house during a visit for a medical matter, but suspect something else might be amiss.
“It’s not necessarily our skillset,” she said.
“So, what we realised we needed was the ability to signpost people in the right direction. We’re not in the business of giving direct advice, but we can get them to approach people who can.”
In response, the PCI and MaPS have created the Money Talk Toolkit, a set of guidance and learning tools for health and care professionals in the UK.
“When someone’s struggling to keep up financially, the knock-on effects for their physical health can be severe”
Sarah Murphy
The toolkit contains modules on mental health signposting for patients presenting with financial stress-related illnesses, talking about money with patients, among others. It also includes guidance and a list of places patients can be referred to.
Ms Hebbert said the toolkit encouraged nurses to include finance in their holistic view of patients.
“It’s not shying away, because we have the knowledge,” she said.
“You don’t need the answers, but you just need to be the gatekeeper and sign poster for those who do.
“I often found people were more guarded about their finances than they are about personal physical things, so it’s all about building up a therapeutic relationship.”
She said the present breadth of financial problems, many of which also affect nurses, meant that this was needed more than ever.
“The situation is difficult for everyone, nurses included,” she added.
Dr Emma Hyde, clinical director for PCI, said nurses and other health professonals “lack confidence” in talking to patients about money problems.
“However, if we are to move to a sustainable model of preventative healthcare, then person-centred conversations that are designed to understand all aspects of a person’s life are crucial to equipping them with the tools to manage their own health and wellbeing,” she said.
Sarah Murphy, health and social care lead at MaPS, added: “We’re seeing more and more evidence that suggests there’s no health without financial health and this is really concerning.
“When someone’s struggling to keep up financially, the knock-on effects for their physical health can be severe.
“They may struggle to attend medical appointments or pay for prescriptions, while some can end up living in damp or otherwise unsuitable conditions, all of which can have long term consequences for their wellbeing. It can also affect their mental health, trapping people in a vicious cycle where money and health problems both continue to spiral.
“Half of health and care professionals say this is increasing, but many don’t feel comfortable raising the topic, so we need to act now. By providing the right training and resources, we can help them direct patients straight to the financial support they so desperately need.”
