Next steps for social prescribing in England - commissioning, scaling up, supporting community and vulnerable groups, and learning from COVID-19 crisisle, 17th September 2020, is the third policy conference on social prescribing, hosted  by the Westminster Health Forum.

These are our posts on two earlier conferences:

http://thefoodiez.net/what-matters-you-personalised-care-approach-health-care

http://thefoodiez.net/social-prescribing-update-progress

Dr Michael Dixon, National Clinical Lead, Social Prescribing, NHS England and Co-Chair, Social Prescribing Network and Chairman, College of Medicine, commented that it feels inconceivable that the conversation about social prescribing began back in 2016, very much as a grassroots initiative, and today people across the country have access to it:

"This is one of the fastest moving social movements in history."

Dr Michael Dixon

James Sanderson, Chief Executive, National Academy for Social Prescribing and Director of Personalised Care, NHS England and NHS Improvement described the four key areas of activity that social prescribing offers.  These are:

Art and Culture including singing for the brain, dancing for Parkinson's and connecting people with art in its various forms.

Physical Activity including football, walking groups, hiking

Natural Environment providing access to the natural environment and the benefits of being part of nature.

Advice and Guidance connecting people with the information that they need for issues like finances and housing.

Dr Dixon described social prescription as being about transforming medical care, what we can do for ourselves and what we can do for others. The National Academy for Social Prescribing, an independent registered charity, was launched in October 2019 with substantial funding.  James Sanderson confirmed that they are currently working on growing their programmes. The Academy will promote social prescribing, create collaborations in national and local government as well as the voluntary sectors, bring together an evidence base to evaluate activities and identify opportunities for innovation, and to share best practice across the system. James Sanderson noted that, in the coming months, the Academy will be launching their Thriving Communities programme, to target local voluntary sector organizations to provide funding for social prescribing activities.

At the start of the summer of 2020, two thirds of Primary Care Networks had a link worker.  James Sanderson confirmed that this number will increase by 500 by the end of this year, and they are well on their way to reaching their goal of 4,500 nationwide. Link workers are at the core of the social prescribing model.  They work in partnership with people to co-produce a personalised care plan to address their needs, with a view to achieving a sustainable behavioural change and support health and wellbeing. A key element of the role is facilitating, connecting and linking people to support. 

Link workers help people to identify the social determinants of health that matter to them, through discussing their issues and find solutions through connecting and linking people with local community groups and agencies that can provide support. Currently, link workers are actively supporting a wide range of vulnerable people, including people with one or more long term conditions, shielded patients, people with mental health issues, people who are lonely or experiencing social isolation, people who have complex social needs which affect their wellbeing, people who have financial and housing issues, carers, and people experiencing domestic violence.

Christiana Melam, Chief Executive Officer, National Association of Link Workers said that the role and responsibilities of link workers varies across the country, depending on the local Primary Care Network's social prescribing model, and suggest that this flexibility is vital to addressing health inequalities, so that the role and responsibilities are tailored at a local level to support the needs of the community.

From a commissioning perspective, assessing the effectiveness of social prescribing has been challenging, as it provides an array of activities that go to the core of communities.  Often, evidence is gathered through patient activation, but Dr Bogdan Chiva Giurca, NHSE National Champion, Social Prescribing and Collaborator, Harvard Global Health Institute stated that measurements should not take precedence when evaluating a service. He highlighted that where the benefits of interventions are common sense and visible, it should be accepted.  Future research should look at the social impact, because often there are chain reactions that occur through interventions.

Professor Sheena Asthana, Director, Plymouth Institute of Health and Care Research, University of Plymouth shared some interesting insight into the social prescribing in practice.  She reported that patients are more likely to accept a referral for social prescribing if they believe that it will be of benefit and if it is presented in a way where the individual can see how it meets their needs, expectations and concerns. Where an activity session has been prescribed, patients are more likely to attend the first session if the activity is accessible in terms of costs, physical accessibility and safety. Some people require a higher level of support, such as being accompanied to the first session, but the high workload of link workers often can't facilitate this. But, it looks that people are more likely to adhere to programmes where activity leaders are skilled, knowledgeable, and maximize confidence among participants.  People who begin to notice changes in their conditions or symptoms are inspired to continue engaging with activities.  So, the quality of services really is key to their effectiveness.

Going forward, Dr Dixon noted that there will need to be change on a number of levels.  There will need to be a change in the education system, so that doctors and nurses are trained to see social prescribing as an intrinsic part of their job and the service that they provide.  It will be crucial for all areas of government to support social prescribing with increased focus and funding. Research and evidence are required to show where and how social prescribing is most effective. And, it is time for social prescribing to go further.  To date, it has been effective in supporting the the long-term sick, the elderly and people with mental health issues.  Dr Dixon feels that it is time to for this to extend to children and young people, into prisons, and to proactively stop one long-term disease becoming several long-term diseases.  One thing is clear, the positive potential of social prescribing continues to evolve and grow. 

"Increasingly we're seeing social prescribing taking on a role of healing sick communities, not just individuals."

Dr Michael Dixon 

Post Contributor:

Caitriona Fitzsimons Digital Reporter