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Evidence‐based approaches

Rationale

More than four in ten people who are working when diagnosed with cancer must make changes to their working lives, with almost half changing jobs or leaving work altogether. However, patients do not seem to be getting enough information and advice from healthcare professionals on working during, or returning to work after, cancer treatment (Macmillan Cancer Support [154]).

There are many benefits that could help patients after they have been given a cancer diagnosis, but the system can be confusing. The benefits patients may be entitled to depend on factors such as age, income and where they live (Macmillan Cancer Support [155]). Research shows that the amount that patients with cancer in the UK are not claiming amounts to around £90 million per year (see Table 27.1).

Table 27.1 Percentage of patients dying from cancer not claiming Disability Living Allowance or Attendance Allowance in the UK and what this means in monetary amounts

Country	Percentage	Amount not claimed by patients
England	39%	Worth ± £81 million
Scotland	32%	Worth ± £8 million
Wales	9%	Worth ± £1.2 million
Northern Ireland	7%	Worth ± £450,000

It is important for cancer nurses to know what benefits are available so they can highlight this to their patients. If patients are unsure of what they are entitled to, nurses should refer them to a benefits adviser.

Although treatment on the NHS is free at the point of delivery, there may still be some costs (e.g. a patient's journey to hospital). However, much of the cost can be reclaimed, which should ease some of the burden (NHS Choices [193]). There are many benefits, grants and help with health costs to which patients with cancer may be entitled. Some of these are outlined in Box 27.1 (Macmillan Cancer Support [162]). Free prescriptions, wigs and fabric supports are discussed in further detail later in this section.

Box 27.1

Financial support and other benefits

1 Help with children's costs

Financial assistance is available to help with the care and education of children and young people

2 Help with bills and housing costs

Council tax reduction schemes are available to help people who are struggling to pay their council tax
Help to pay mortgage interest payments may be available
Patients on a low income or already on benefits may be able to get help to pay for their accommodation
There is help for patients with cancer who are struggling with their energy costs

3 Help with health costs

Patients may be eligible for free prescriptions if they have cancer. There are also other ways to help with the cost of medications
Some patients may be able to get free eye tests if they meet certain criteria
Patients may be able to get free wigs and fabric supports
The Low‐Income Scheme may help patients who still have to pay healthcare costs but may be on a low income
Patients may qualify for free dental treatment

4 Help with transport and parking

Patients may be able to get financial help for mobility equipment or nursing home charges
Patients may be able to get help with their travel costs to and from hospital for treatment
Patients may qualify for schemes that help them to buy or rent a car, scooter or powered wheelchair
Patients may be eligible for special travel rates or community transport services in their area
Older people and people with disabilities can often get free or discounted travel fares
The Blue Badge Scheme can help with parking costs if patients have severe mobility problems

5 Financial information for people whose cancer cannot be cured

There may be benefits that the patient can claim towards the end of life
Some charities and organizations offer grants to people with cancer to help with financial problems

Patient can get help to sort out their bank accounts and pensions towards the end of life

Source: This information is based on content originally produced by Macmillan Cancer Support and is adapted with its permission. Details are correct at the time of publication.

Free prescriptions

Prescription charges for cancer patients were abolished on April 1 2009 (NHS Choices [193]). Exemption certificates are now issued to those patients who, in their doctor's judgement, are receiving treatment for:

cancer
the effects of cancer
the effects of current or previous cancer treatment.

To apply for a medical exemption certificate (MedEx), patients must ask their doctor for an FP92A form. Their GP, hospital or doctor will sign the form to confirm that the information provided is correct.

The certificate is valid from 1 month before the date that the NHS Business Authority receives the application form.
The MedEx lasts for 5 years and then needs to be renewed, which is the patient's responsibility.
Further information about the application process and refunds can be found on the NHS Business Authority's website (www.nhsbsa.nhs.uk/).

Wigs and fabric supports

Wigs and fabric supports are free of charge on the NHS (Cancer Research UK [36]) if patients:

are treated as an inpatient
are under 16 years old, or between 16 and 19 years old and in full‐time education
have a partner who is getting Universal Credit, Income Support, income‐based Jobseeker's Allowance or the guarantee credit of Pension Credit
have an NHS tax credit exemption certificate
are named on a valid ‘help with health costs’ (HC2) certificate.

There are no nationally set limits on the number of wigs a patient can have from the NHS. However, there is nothing preventing local NHS organizations from setting their own limit (NHS Choices [193]).

If patients are on a low income but do not qualify for a free wig, they may still be able to get some assistance. This is explained in the Department of Health leaflet called ‘Help with health costs’ (HC11; https://www.nhsbsa.nhs.uk/sites/default/files/2017‐12/HC11%20%28V7%29%20online%2011.2017.pdf). The leaflet is available from the hospital or at post offices. If the patient is entitled to help, they will receive either a full help certificate (certificate HC2 means they do not need to pay for their wig) or a limited help certificate (certificate HC3 means they may get some help with the cost).

If the patient is being treated as an outpatient and does not otherwise qualify for a free wig, they must pay for one (NHS Choices [193]).

If the patient decides to buy a wig privately, it is worth noting that they do not have to pay Value Added Tax (VAT) on a wig that is bought for hair loss caused by cancer treatment. However, they must fill in a VAT form at the time they buy their wig. The supplier should provide this form because they cannot claim the VAT back later (Cancer Research UK [36]).

In addition to wigs, cancer patients are also entitled to VAT‐free products and services if they are designed and/or adapted for a disability. These include certain types of adjustable beds, alarms, wheelchairs and stair lifts. An exhaustive list can be found on the gov.uk website (https://www.gov.uk/financial‐help‐disabled/vat‐relief).

Scope

It is not within the scope of this chapter to explore all benefits available within the welfare system. The following focuses on the benefits that are most relevant to patients with cancer:

Personal Independence Payment
Attendance Allowance
Carer's Allowance
Employment and Support Allowance
Universal Credit.

Eligibility/non‐eligibility

Most patients with cancer will need help and support from people who know about the different benefits. They may need to fill in several forms and make phone calls. It can be time consuming and very stressful at what is already a difficult time (Cancer Research UK [38]). Cancer nurses should explore with patients what their social and occupational needs are as part of the holistic needs assessment (National Cancer Action Team [183]) and from this they will get an indication of what support is needed. See Section c27-sec-0003 for more information about the HNA for patients with cancer.

Table 27.2 sets out what the eligibility criteria are for Personal Independence Payment, Attendance Allowance, Carer's Allowance and Employment and Support Allowance (Department for Work and Pensions [DWP] 2018).

Table 27.2 Eligibility/non‐eligibility for Personal Independence Payment (PIP), Attendance Allowance (AA), Carer's Allowance (CA), Employment and Support Allowance (DWP [71], [72], [73], [74], [75])

Benefit	Eligible	Not eligible
Personal Independence Payment (PIP)	Aged 16–64 (DLA remains for children up to age 16 and DLA recipients aged 65 or over on 8 April 2013 [the day that PIP was introduced]) Have a long‐term health condition or disability and difficulties with ‘daily living’ or getting around (see Table 27.4) Be in Great Britain when making a claim. There are some exceptions, for example members and family members of the Armed Forces Have been in Great Britain for at least 2 of the last 3 years Be habitually resident in the UK, Ireland, Isle of Man or the Channel Islands	Those subject to immigration control (unless a sponsored immigrant) Those who do not satisfy the residence conditions
Attendance Allowance (AA)	Aged 65 or over Have a physical disability The disability is severe enough for the claimant to need help caring for themselves or someone is needed to supervise them, for their own or someone else's safety Be in Great Britain when making a claim. There are some exceptions, e.g. members and family members of the Armed Forces Have been in Great Britain for at least 2 of the last 3 years Be habitually resident in the UK, Ireland, Isle of Man or the Channel Islands There are some exceptions to these conditions if the patient is living in another European Economic Area (EEA) country or Switzerland	Those subject to immigration control Those who do not satisfy the residence conditions Those in hospital/residential care
Carer's Allowance (CA)	The person cared for must already get one of these benefits: Personal Independence Payment – daily living component Disability Living Allowance – the middle or highest care rate Attendance Allowance Constant Attendance Allowance at or above the normal maximum rate with an Industrial Injuries Disablement Benefit Constant Attendance Allowance at the basic (full day) rate with a War Disablement Pension Armed Forces Independence Payment The claimant might be able to get CA if all the following apply: Aged 16 or over Spend at least 35 hours a week caring for someone Have been in England, Scotland or Wales for at least 2 of the last 3 years Normally live in England, Scotland or Wales, or live abroad as a member of the Armed Forces Not in full‐time education Not studying for 21 hours a week or more Earn no more than £116 a week (after taxes, care costs while claimant is work and 50% of what claimant pays into pension) – pension is not counted as income Might still be eligible if moving to or already living in another EEA country	Those over pensionable age Those subject to immigration control Those who do not satisfy the residence conditions
Employment and Support Allowance (ESA)	Be under State Pension age Not getting Statutory Sick Pay or Statutory Maternity Pay and have not gone back to work Not getting Jobseeker's Allowance Claimant may apply if employed, self‐employed, unemployed or a student on Disability Living Allowance or Personal Independence Payment Claimant may get ESA if they have lived or worked abroad and paid enough UK National Insurance (or the equivalent in an EEA or other country with which the UK has an agreement)	Those found capable of doing some work after their ‘Work Capability Assessment’. The main exceptions are: where their current condition has become a lot worse where they are claiming for a new condition those receiving Universal Credit
Universal Credit	Can currently claim Universal Credit if either: a single person anywhere in England, Wales and Scotland a couple or family living in certain areas To get Universal Credit, claimant must: be 18 or over be under State Pension age not be in full‐time education or training not have savings over £16,000 Less Universal Credit if claimant has savings over £6000 or earns enough money to cover basic living costs. If living with partner will need to make a joint claim as a couple. Partner's income and savings will be taken into account, even if they are not eligible for Universal Credit If claimant wants to claim a benefit without their savings, partner's savings or their income being taken into account, can apply for either: ‘new style’ Jobseeker's Allowance (JSA) ‘new style’ Employment and Support Allowance (ESA) Claimant can apply for these if entitled to apply for Universal Credit If claimant has children he/she can make a new Universal Credit claim either: if claimant has two children or fewer and lives in a Universal Credit area received Universal Credit in the previous 6 months and payments have stopped – it does not matter how many children there are. If claimant has three or more children and has not claimed Universal Credit before, he/she can apply for Child Tax Credit If claimant has a disability or illness that affects his/her work Claimant may need to have a work capability assessment to see how disability or health condition affects his/her ability to work. If an assessment is needed, claimant will get a letter telling them where to go and what to do Depending on the outcome of assessment, claimant could be eligible for an extra payment on top of standard allowance	Unable to claim Universal Credit if in receipt of the following benefits: Income Support income‐based Jobseeker's Allowance income‐related Employment and Support Allowance income‐related Incapacity Benefit Subject to immigration control

DLA, Disability Living Allowance.