Several high quality qualitative studies conducted in the United Kingdom primary care context have found that additional income gained as a result of welfare rights interventions was commonly spent on settling bills such as fuel payments, and affording more or better quality food [16, 33–37]. The extra income enabled people to get out more, participate in daily activities and maintain social contact by covering the costs of transport and social activities [33–37] and for some, it enabled access to paid-for health services such as dentistry, eye care and home help [16, 33, 36]. Successful welfare claims were a gateway to other forms of non-financial help, such as free prescriptions, respite care, meals on wheels and home modifications [38]. Reduced financial pressure had benefits for personal independence and eased strain on family relationships [37, 38]. High quality quantitative surveys of clients accessing welfare rights advice in United Kingdom primary care settings found self-reported improvements in knowledge, empowerment and confidence as a result of the interventions [39, 40]. Qualitative evidence reflects this: interview studies have identified increased confidence and empowerment resulting from welfare rights interventions [14, 41–43], leading to improved ability to use other services [14], coming off drugs and entering education and training [43], being more open with healthcare staff about their situations [42], and being able to focus on their health [41]. A small-scale survey conducted in the United States showed significant reductions in the proportion of families avoiding healthcare for their children due to financial concerns [44].

High-quality studies conducted in United Kingdom primary care found that people referred to advice by healthcare professionals would not otherwise have sought assistance [31, 38, 45]. Qualitative evidence showed that healthcare-based provision facilitated access for certain groups such as older people [46–48] and those in poor mental and physical health [14, 45, 49]. Studies of service user experiences identified that the healthcare environment was conducive to seeking help with legal issues because it felt familiar and trusted, discreet and confidential, less stigmatized, often less far to travel and somewhere people felt comfortable discussing anxieties [16, 31, 45, 48, 49]). Referrals from primary care staff encouraged help-seeking, legitimizing the receipt of welfare assistance as part of a wider holistic approach to care [31, 33, 38]. The trusting relationship with healthcare professionals facilitated patients’ engagement with legal advisers [14, 48, 50]. Studies conducted in United Kingdom cancer services highlighted that patients with serious illness may not have the physical or mental strength to pursue legal processes or may assume they are not entitled to help unless alerted by healthcare professionals [51, 52]. Quantitative outcomes reflect similar themes: surveys of clients accessing welfare support in United Kingdom primary care estimated that 66% would not have accessed assistance had they not been referred by a healthcare professional [53], and that almost half (45–49%) of HJP clients would be unlikely to seek advice elsewhere [39, 54]. Features of the healthcare setting that clients rated ‘very important’ to them included closeness (78%), a place they trusted (80%), a place they knew (73%), and that it was anonymous (43%) [39]. In a United States pediatric hospital setting, 85% of clients had not used legal resources before accessing the service, and 79% had not been aware of legal resources [44].

Experimental studies of health outcomes had only been conducted in the United Kingdom primary care setting: two papers reported pilot randomized controlled trials, of which one was insufficiently powered for statistical analysis [29]. The other found little evidence of any changes over time (at 24 months following the intervention) or differences between intervention and control groups across a range of health, behavioral and psycho-social outcomes; however, study design limitations may have affected the potential to demonstrate change [55]. A quasi-experimental study explored the effects of co-located welfare rights advice in primary care compared with a propensity score-weighted comparison group [40]. This study showed an improvement in mental wellbeing among individuals whose situation improved as a result of advice, significant reductions in rates of common mental disorders among women and participants of a Black/Black British ethnicity, and improvements in stress levels.

Uncontrolled prospective studies have been conducted in a variety of settings. In United Kingdom primary care, improvements in mental health and emotional role functioning were found where income had increased as a result of financial interventions [33, 34]. A small-scale study conducted in a hospital setting in the United States showed significant reductions in asthma severity and medication usage for adult asthma patients receiving a housing intervention [56]. In a family medicine clinic in the United States, perceived stress among adult patients or carers reduced significantly following receipt of legal assistance, and this change was strongly associated with the level of concern regarding legal issues [57]. In veterans’ medical centers in the United States, veterans receiving a greater level of input from legal services showed greater improvements in mental health and general health scores [58].

Qualitative studies conducted with patients receiving legal assistance in a variety of healthcare settings internationally have reported reduced feelings of stress and anxiety [16, 36–38, 42, 51], improved mental stability [16, 38], greater peace of mind and reassurance [35, 36, 51], hope [42], better sleeping [16, 38], improved wellbeing and quality of life [36, 37] and increased ability to cope with ill health [36, 37]. Two papers developed theories of change as to how welfare advice interventions may lead to improved health [14, 52]: the models propose that legal assistance brings about improved circumstances (material, financial and practical) which leads to reduced stress and anxiety, improved ability to focus on health and participate in daily life, and ultimately better mental and physical wellbeing. There were fewer indications in the qualitative studies of perceived impacts on physical health. One good quality paper from a United Kingdom primary care setting described patients reporting heathier behaviors, including reduction or cessation of smoking, improved diet and physical activity, reversal of weight loss and changes in medication [38], but no other studies have confirmed these findings.

Two studies have assessed legal outcomes against a comparison group, both focusing on welfare rights interventions in the United Kingdom primary care setting; they found significantly greater improvements in financial strain [40] and financial vulnerability [55] in the following months for people receiving the intervention. Studies conducted in a variety of settings have highlighted high success rates for legal assistance in obtaining welfare support and increasing the incomes of recipients [33, 34, 36, 52, 59–61]. Internationally, reports consistently showed significant amounts of money were received as a result of legal assistance, as lump sums and regular ongoing contributions to income [31, 35, 36, 47, 50, 52, 59–68]. Other financial outcomes included preventing benefits stoppage [59], managing debts [50, 65], reducing use of credit cards [40] and obtaining access to healthcare insurance [69, 70]. Qualitative research has highlighted the importance of this financial assistance in easing difficult situations and helping to mitigate the financial consequences of illness [38, 52]. Other legal issues resolved successfully through HJP interventions internationally included housing circumstances and homelessness [40, 63, 69, 71, 72], education [63, 69, 71, 72], family stability [63, 69], employment [63], wills and power of attorney [66], utility shut-offs [73] and food supports [44, 63].

Feedback gathered from project staff in a variety of international settings suggests that HJPs provide a more rounded service for patients, addressing interconnected health and welfare issues in a comprehensive way [5, 16, 74]. Partnership working between health and legal services helped to resolve issues affecting health and wellbeing and was felt to make a positive contribution to patient care [45, 75]. Patients reported valuing the continuity of support, familiarity and personalized service [16]. Those with serious illness felt that proactive assistance with social welfare rights issues was an important part of non-medical care, and should be made available to support patients [51]. Studies reporting views of clinicians have highlighted that being able to offer legal support can improve patients’ confidence and trust in the health service and contribute to stronger doctor-patient relationships [50, 54].

Studies had investigated whether HJPs could reduce pressure on health services by reducing care utilization. The only experimental study investigating this outcome did not have sufficient statistical power to show significant changes [29]. A quasi-experimental controlled study found no significant changes in primary care consultation rate in response to a welfare rights intervention in the United Kingdom [40]. Evidence from uncontrolled follow-up studies did not show a consistent pattern: two studies suggested reductions in service use, in response to a housing intervention for asthma patients delivered in a hospital setting in the United States [56] and welfare rights advice delivered in a United Kingdom primary care context [76]. However, others have found no significant changes, including in response to welfare rights advice in United Kingdom primary care [33] and legal assistance for low income families in a children’s hospital in the United States [44]. One study identified instances of earlier discharge from a United Kingdom hospital: financial awards had enabled patients to secure suitable accommodation and necessary care packages to return home from intensive care [77].

In the United States where access to health insurance is not universal, legal services had obtained insurance cover for patients and intervened against complex insurance denials, thereby facilitating access to needed healthcare [69, 70]. HJPs focusing on patient access to health insurance in the United States have been found to generate significant sums of money for hospitals through health insurance reimbursements [78]. This supports return on investment by the healthcare partner and allows patients to engage with preventative health care, reducing the likelihood of future health emergencies [78]. A qualitative study from the Ukraine found that providing legal assistance in harm reduction services for drug users led to increased engagement with preventative healthcare among this group [41].

High quality studies exploring perspectives of healthcare professionals in the United Kingdom and Canada report that partnerships with legal services can be a beneficial resource to support them in their work: clinicians reported that these partnerships provide an opportunity to address patients’ non-medical issues outside their expertize [14, 16, 33, 49] and that this was potentially time-saving as it meant they did not have to address legal issues themselves and could focus on individuals’ health and care needs [14, 16, 42, 49]. Healthcare professionals have been found to report better job satisfaction as a result of partnerships with legal services, due to feeling able to perform their role more effectively [14] and feeling satisfied at providing a good service for patients [33, 42, 49].

Studies had not specifically investigated whether HJPs were effective in reducing health or social inequalities. One study investigated differential mental health outcomes across gender, ethnicity and health status; it found that women and participants of a Black/Black British ethnicity were particularly likely to benefit in terms of common mental disorders as a result of a welfare rights intervention in United Kingdom primary care [40]. Targeting housebound patients resulted in greater financial benefit for this group than for patients attending surgery-based welfare rights advice sessions [31].

HJPs occupy a unique position at the intersection of health and rights [79], which enables them to identify patterns of discriminatory or harmful practices and community-level health risks [41, 80, 81]. Case studies from the United States demonstrate a number of ways in which partnerships have addressed population-level health risks, including through action against landlords to improve living conditions [71], changes in legislation that include new health and safety laws [82], provision of adequate services for people with disabilities and mental illness [83], and extra protection for vulnerable groups facing utility shut-offs [84]. Contributing to court cases, government enquiries and public consultations is another way that partnerships have exerted influence at systemic level. Examples from countries across the world highlight the impact of these activities in contributing to changes in the welfare eligibility laws [15], giving voice to vulnerable groups in the legislation process [43], informing organisational responses to family violence and elder abuse [85] and contributing to human rights work for families and children [86].