The Kings Fund recently published an update read on Social Prescribing. As a charity our hope is that articles like this are important to move the Social Prescribing conversation forward.
Social Prescribing after a decade of implementation it is no longer an innovation. What is important is how it has been interpreted across the UK, and how it has been implemented in neighbours to maximise the value it provides to local communities.
The question is no longer whether commissioners should invest in social prescribing, but how do commissioners ensure that commissioning and delivery of Social Prescribing is credible, sustainable and proportionate to the challenges within their local areas.
For commissioners and policy makers, this next phase of local delivery models matters to supporting people within their own communities as well as primary and community health and care staff. We fully support The Kings Fund view that there is an opportunity to develop social prescribing models that are genuinely community led, shifting resources into communities where the wider determinants of ill health play out.
Neighbourhood Functions
One of The Kings Funds clearest messages is that patient outcomes in Social Prescribing are shaped less by individual roles and more by the system around them. Simply establishing a telephone Single Point of Access, or placing a linked work into primary care without sufficient community wrap-around capacity, or deep local system integration, risks reducing Social Prescribing to a signposting exercise and setting the role up to fail and not make any meaningful impact to individuals who need help, or support demand management on the local health and care system.
The Rainbow Foundation Social Prescribing Service Model reflects this learning in practice. The service works at a neighbourhood-level intervention, with a detailed understanding of local NHS Pathways, voluntary and community sector provision and the informal support networks across Wrexham. This system knowledge is intentional and has been developed over the years based on a process of continuous service improvement.
Crucially, we have found that most referrals into the system are for people with mental health and wellbeing needs. Rainbows Social Prescriber are trained mental health practitioners and have previously worked as mental health nurses or are trained experienced counsellors. The ability to bring a psychologically informed way of working allows them as a Social Prescribing Team to understand ranges of complexity, assess needs holistically and respond appropriately to the needs of the individual accessing the service.
Social Prescribing offered in this way means the service is active and relational support. Individuals are supported to clarify what matters to them, co-produce realistic plans, engage with appropriate services for their needs, and to take ownership to review and adapt their plan over a defined period supported with recognised measurement tools like SWMWBS.
There is no suggestion that Social Prescribing will fix NHS demand pressures or health inequalities alone. However, there is a need for Commissioners to look at cost benefit analysis from the perspective of quality of outcomes for patients who access the service. This is an important part of the solution to health care demand, when Social Prescribing is designed as a service model within a neighbourhood team, and not simply as a referral endpoint.
Evidence that is credible not exaggerated
The King’s Fund is careful in its assessment of the evidence base for Social Prescribing. Over the last five years, nationally and internationally we have seen a growing body of positive data around wellbeing outcomes for individuals, there is less controlled investigation into the variations in delivery models and the evaluations of the outcomes for people accessing the service, the health and care system and the local communities, especially in relation to demand avoidance and cost savings to health and social care.
Using SWMWBS with every client who is supported by The Rainbow Foundation Social Prescribing Team, at the beginning, middle and end of the interventions, means we have a bank of validated measures which has provided us as a service with powerful information on the impact our team has on the lives of local people. The service by itself is not a stand-alone silver bullet for NHS and Social Care system pressures or entrenched public health inequalities. However, the service model does mean we can evidence a clear important role to help people with lower tier mental health and wellbeing needs by appropriately trained staff and frees up capacity within primary care and community mental health, for those professionals to support people who need their expertise. It also helps stop people deteriorating by providing preventative health and wellbeing interventions.
For policymakers, credible evidence for social prescribing needs to be transparent, proportionate and honest about attribution, as part of a wider health and care neighbourhood team.
Mitigating Inequalities
The Kings Fund article points out that Social Prescribing should not be framed as a panacea to reduce demand on NHS and Social Care. Poverty, insecure housing, and employment all have an impact on people’s physical and mental health and wellbeing and sit well beyond the reach of any single-service model. The expectation that Social Prescribing can solve inequality is neither realistic nor fair.
From experience, this caution can sometimes be misinterpreted as evidence that social prescribing primarily benefits more advantaged, articulated or motivated groups of people. It is unfortunately not uncommon to hear the claim that Social Prescribing is “For middle-class people”. This is not our experience and analysis of our SWMWBS shows that older men living in areas of high deprivation have the largest positive improvement in mental health and wellbeing, through intervention with The Rainbow Foundation Social Prescribing Model.
Inequitable of outcomes are a consequence of how services are designed, implemented, delivered and most importantly integrated into the wider system.
The uncomfortable truth about VSCE delivery
Social Prescribing at scale depends heavily on voluntary and community sector organisations that are historically under-funded and short term commissioned and expected to absorb increased demand without corresponding investment.
Our service illustrates the strengths of Social Prescribing and the fragility of investment of the service model. The service works because it is delivered by The Rainbow Foundation as an established VSCE organisation grounded in service development through continuous monitoring, learning and improvement. We have trusted relationships locally as well as the flexibility and local knowledge to function effectively. At the same time however the service, supporting local people through local GP practice and employing local people as Social Prescribers is vulnerable to commissioning challenges. Models like ours cannot be sustained indefinitely through short-term funding cycles.
For Policy Makers, we believe the implication is clear. Social Prescribing is part of core system infrastructure and therefore must be commissioned accordingly to further develop the services and realise the full benefits of an enhanced social prescribing service. Funding, workforce planning, performance expectations reflecting the nature of the work rather than VSCE services being seen as a discretionary add-on.
It is clear to see, from our work locally that the social prescribing team here in Wrexham has made a meaningful positive impact to the people they have helped in their local communities.
