1. Social Prescribing: An emerging area for occupational therapy practice
Social Prescribing: An emerging area for occupational therapy practice? Senior Lecturer Leeds Beckett University Miranda Thew

2. Aims Public health agenda Understanding Social Prescribing
A Role less travelled!
Exploring ideas for an occupational therapist role.

3. Social Prescribing- nothing new!
Social prescribing has been used in some form in the NHS since the 1990s (South et al., 2008).
Increased interest and investment by UK government to include a wider range of community interventions and activities (NHS England, 2014).
It is now being used to facilitate a more sustainable NHS (Dyson, 2014).

5. State of the Nation…

6. The background
2008, -National Institute for Health and Care Excellence (NICE) introduced its guidance (PH9) on Community Engagement and Development for those working in local authorities, the community, voluntary and private sectors.
NICE reported that there were ‘gaps’ in the evidence to support community-based health initiatives.
2010- the Institute of Health Equity (IHE), University College London (UCL) published its report on a review conducted by Professor Sir Michael Marmot, ‘Fair Society Healthy Lives’.

7. Marmot Review (2010)
The ‘Marmot Review’ proposed an evidence-based strategy to address inequalities in the health, distribution of health, and social and economic conditions across England. 6 Recommendations:
give every child the best start in life;
provide education and lifelong learning;
provide employment and working conditions;
define and provide a minimum income for healthy living;
provide safe and sustainable housing and communities;
and use a ‘social determinants’ approach to disease prevention

8. Social Determinants of health
People’s health is determined primarily by a range of social, economic and environmental factors.
Social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health.

9. Development on Social Prescribing
Between 2012 and 2014, the results of several pilot studies of social prescribing began to emerge.
These studies contributed to developing the ways (pathways) in which social and community services could be organised.
2014, NHS England responded to the Marmot Review in its Commissioning Toolkit to Reduce Health Inequalities.
In Section 8 of this report, NHS England specifically included social prescribing pathways to bring together primary care and community care.

10. Office of Civil Society (replaces Office of the Third Sector)
“This government values the economic and social contribution of Britain’s charities, social enterprises and voluntary organisations, and the extraordinary work individual people do to improve the lives of others and of the most disadvantaged”
Government policy will focus on three fundamental issues:
• Making it easier to run a charity, social enterprise or voluntary organisation.
• Getting more resources into the sector: strengthening its independence and resilience.
• Making it easier for sector organisations to work with the state
Nick Hurd- Ex-Minister for the Civil Society

11. The added ‘burden’ of chronic mental ill health

12. No Health without Mental Health (DOH, 2011)
Development of a cross government approach to address the issue with a focus on outcomes for people with a mental illness as a way of developing and promoting solutions to reduce the burden.
The emphasis in mental health services has moved towards the development of a more person centred approach based on principles of SP

13. Social Prescribing Projects.
The kinds of interventions or activities that are being considered for GP referral as part of the Social Prescribing strategy range from ‘Knit and Natter’ Clubs, health promotional educational groups, Arts, creativity, learning and exercise on referral to fishing clubs (Dyson 2014).

14. Social Prescribing: influence
But what characterizes SP most is that they are services that are purportedly offering a holistic approach to a patient.
SP is a route to reducing social exclusion particularly in disadvantaged populations with enduring mental health problems.

15. Definition and descriptions
A means of enabling healthcare professionals to refer patients to non-clinical services that can help meet such needs.

16. Five Year Forward View
Following the publication of NHS England’s Five Year Forward View, in November 2014, social prescribing is being driven as a key factor in facilitating health in the community.

17. The Potential market for OT…
The third sector has a ‘vital role to play in helping the country deal with the public sector spending squeeze ahead.
The scope for the profession needs to be realised in order for Occupational Therapy to grow (Thew et al., 2010)

18. Social Prescribing & Occupational Therapy
Does social prescribing sound a lot like occupation focused therapy to you? Why are Occupational Therapists not involved in research or in developing the concept? What could our potential role be?

19. An example: facilitate employment

20. Lets look at a population example –discussion point
Time to think out of the box!
Lets imagine an occupational therapist post commissioned to cover a very deprived part of a city.
What areas could an occupational therapist work in?
What would be our potential role?

21. Thinking right out of the box!
Where is occupational Therapy with one of the most burdensome problems in the NHS?
OBESITY?

22. Statistics- obesity
UK spends £6 billion a year on the medical costs of conditions related to being overweight or obese and a further £10 billion on diabetes
There was a marked increase in the proportion of adults that were obese from 13.2 % in 1993 to 26.0 % in 2013 for men, and from 16.4 % to 23.8 % for women.
In reception year (aged 4-5) in 2013/14, the proportion of obese children (9.5 %) was lower than in 2006/07 (9.9 %).

23. Obesity
1 in 5 UK 5 year olds and 1 in 3 in 10 year olds are overweight or obese (Dip, 2015).
Children of all ages are twice as likely to be obese in the most deprived areas as in the least deprived areas.
(Master and Kingdom, 2015).

25. So, what could Occupational therapy offer?
Group 2:
Come up with a community based intervention for adults eligible for bariatric care on a SP agenda
Group 1:
Come up with a community based intervention for overweight children on a SP agenda

26. References
Dip, P. (2011) Health and economic burden of the projected obesity trends in the USA and the UK. The Lancet (11) KIMBERLEE, R. (2015) What is social prescribing?. Advances in Social Sciences Research Journal., 2, (1). doi: Knapp M, McDaid D, & Parsonage M. (Eds.). (2011). Mental health promotion and mental illness prevention: The economic case. London: Department of Health. McKinsey Global Institute (2014) Overcoming obesity: An initial economic analysis McKinsey and Company Master, W. and Kingdom, U. (2015) Statistics on Obesity, Physical Activity and Diet: England 2015; Health and Social Care Information Centre available at: South J, Higgins T, Woodall J. and White S. (2008). Can social prescribing provide the missing link? Primary Health Care Research & Development, 9, pp doi: /S X.