1. Brighton– Fri 26th April 2018
Opportunities and challenges to the sustainability of social prescribing
Dr. Marcello Bertotti
Senior Research Fellow
Institute for Health and Human Development, University of East London
Co-lead London Social Prescribing Network
UCLPartners Improvement Fellow
THANK YOU FOR THIS OPPORTUNITY TO TALK ABOUT SOCIAL PRESCRIBING
I AM A SENIOR RESEARCH FELLOW AT UNIVERSITY OF EAST LONDON AND HAVE BEEN INVOLVED IN THE DEVELOPMENT OF SOCIAL PRESCRIBING FOR THE LAST 2-3 YEARS.
APART FROM REPRESENTING MYSELF, I AM ALSO A STEERING GROUP MEMBER OF THE SOCIAL PRESCRIBING NETWORK WHICH GROUPS TOGETHER OVER 1,500 PEOPLE INVOLVED IN THE DEVELOPMENT OF SP ACROSS THE UK AND NORTHERN IRELAND

2. Outline Why do we need social prescribing and what is it?
Key opportunities and challenges for the sustainability of social prescribing
Concluding remarks
A look at the evidence base around the effectiveness of interventions tackling social isolation/loneliness.

3. WHY DO WE NEED SOCIAL PRESCRIBING?
Frequent attenders to primary care: In the UK, 20% of patients attend GP for social rather than medical reasons. It costs the NHS £395m per year (Citizen Advice, 2016)
Increasing rate of Long Term Conditions. E.g. diabetes. The WHO (2012) estimated that in ,000 died of human violence (war and crime), 1,500,000 died of diabetes.
‘Sugar is more dangerous than gunpowder’ (Harari, 2017).
Persistent level of health inequality (Cawston, 2011). This lead to long-term medical conditions and particularly affects people in disadvantaged areas

4. WHAT IS SOCIAL PRESCRIBING?
PATIENT
CLIENT
USER
PERSON?
Primary Care (GP)
ATTENDANCE in VCSE sector
Statutory sector (e.g. LA; Housing)
*TIME WITH A NON-CLINICAL LINK WORKER
Allied HCP
Secondary Care (Hospital)
Based on Polley (2018)

5. Patient/client/person/user
Long term conditions (e.g. diabetes)
mild/moderate MH problems,
social isolation/loneliness,
social problems (e.g. housing, employment)
Primary, secondary care
Statutory sector
Allied HCP
Link worker
A RANGE OF DIFFERENT CONDITIONS
PREVENTION AND TREATMENT (E.G. AT RISK OF DIABETES OR WITH DIABETES)
MH PROBLEMS HISTORICALLY IT STARTED LOOKING AT MH.
THERE IS NOW EMPHASIS ON SELF-CARE E.G. DIABETES, OR LONG TERM CONDITIONS
APOLOGIES I INCLUDED LONG TERM CONDITIONS TWICE
PATIENTS/CLIENTS/PEOPLE: THIS REFLECTS THE DIFFERENT PARTS OF THE SYSTEM SEE PEOPLE
Voluntary sector

6. Primary/secondary care Statutory sector Allied HCP
Patient/client/person/user
Primary/secondary care
Statutory sector
Allied HCP
Mainly GP practices
Social workers (local authority)
Housing associations
Pharmacies
Hospitals
Link worker
Different reasons and different focus
Voluntary sector

7. Link worker Patient/client/person/user Coaching, motivation, listening
Primary, secondary care
Statutory sector
Allied HCP
Coaching, motivation, listening
Co-production with user
Knowledge about community activities
Intensity of support:
Signposting (one session)
Referring (flexible; > one session)
Link worker
Link workers, community navigators, well-being coordinators, referral facilitators …..
LINK WORKERS HAVE MANY DIFFERENT NAMES
NAVIGATORS, WELLBEING COORDINATORS,
BUT ESSENTIALLY THEY TEND TO HAVE TWO KEY QUALITIES:
1. THEY NEED TO BE ABLE TO SUPPORT AND LISTEN TO PEOPLE AND OFTEN HAVE COACHING AND/OR MOTIVATIONAL SKILLS.
2. THEY HAVE KNOWLEDGE ABOUT COMMUNITY ACTIVITIES. THIS IS AN IMPORTANT FEATURE OF THEIR WORK BECAUSE COMMUNITY ORGANISATIONS COME AND GO, SO THEY CAN REFER PEOPLE TO SERVICES THAT ARE ACTUALLY ACTIVE.
AS MOST GPS DO NOT KNOW ABOUT SERVICES AVAILABLE IN THE COMMUNITY, THEY CAN RELY ON LINK WORKERS TO REFER PEOPLE EFFECTIVELY.
SIGNPOSTING AND DELIVERY: THIS IS A KEY DIFFERENCE BETWEEN DIFFERENT MODELS OF SOCIAL PRESCRIBING. SIGNPOSTING IS LIGHT TOUCH AND INVOLVES A QUICK MEETING OR TELEPHONE CONVERSATION BETWEEN LINK WORKER AND PATIENT
REFERRAL INVOLVES MEETING WITH PATIETNS UP TO SIX SESSIONS FOR EXAMPLE. IT IS IMPORTANT TO REMARK HERE THE FACT THAT THE AVERAGE GP CONSULTATION WITH PATIENTS IN THE UK IS 11.2 MINUTES. THUS LINK WORKERS OFFER TIME AND LISTEN TO PATIENTS’ CONCERNS.
Voluntary sector

8. Voluntary sector Patient/client/person/user Primary, secondary care
Statutory sector
Allied HCP
Volunteering
Housing and employment advice
Psychological counselling
Walking clubs; sport clubs
Cook and eat sessions
Lunch clubs
Gardening
Group art and dance
Museum, books e.g. art on prescription
Conservation
Link worker
WIDE RANGE
Voluntary sector

9. KEY OPPORTUNITIES FOR SUSTAINABILITY OF SOCIAL PRESCRIBING

10. Financial sustainability
the NHS funding gap is unsustainable (estimated at £16b by 2020/21, at the current level of savings)
SP shows a decline in:
GP consultation rates (28%),
A&E attendance (24%)
Emergency hospital admissions (6-33%)
An average increase in Social Return on Investment (£1:£2.3).
TOTAL NHS EXPENDITURE. TOTAL EXPENDITURE £185B. 10% increase!!

11. sustainability: growing evidence shows that SP improves health outcomes, social connections
Social Prescribing can contribute to the financial sustainability of the NHS by complementing clinical treatment (bio-medical) with non-clinical support opportunities for patients (psycho-social).
AN IMPORTANT PART OF WHY WE NEED SOCIAL PRESCRIBING IS THE RECOGNITION THAT ECONOMIC, ENVIRONMENTAL AND SOCIAL INEQUALITIES CAN DETERMINE PEOPLE’S RISK OF GETTING ILL, THEIR ABILITY TO PREVENT SICKNESS AND THEIR ACCESS TO EFFECTIVE TREATMENT.
INIDIVIDUAL ARE PLACED AT THE CENTRE OF THIS FAMOUS MODEL BY DAHLGREN AND WHITEHEAD. SOCIAL PRESCRIBING SIMILARLY ATTEMPTS TO PLACE THE INDIVIDUAL AT THE CENTRE OF THE MODEL AND SUPPORT THAT INDIVIDUAL WITH THEIR HEALTH, SOCIAL, ECONOMIC NEEDS BY REFERRING THEM TO A RANGE OF SERVICES IN THE COMMUNITY, NOT JUST HEALTH SERVICES.

12. Shift to an asset based rather than deficit based system:
Environmental sustainability: it promotes a different relationship between people and their environment. (e.g. natural health service).
Shift to an asset based rather than deficit based system:
voluntary sector: dynamism of the voluntary sector for the renewal of communities and urban areas.
it creates social capital for the benefits of communities.
Person centred: user has a ‘voice’ in their treatment

13. KEY CHALLENGES FOR SUSTAINABILITY OF SOCIAL PRESRIBING

14. NHS is not funding SP nationally as yet despite financial cliff
Prevention is still at the margins of NHS spending (in 2015, only 5.2% of NHS budget was invested in prevention (£9.8b)
The evidence base needs improving: Larger samples, longer follow ups, data monitoring, designs with control groups, more tailored outcome measures
Voluntary and third sector funding has declined substantially following cuts to local authority budgets
Need to work on ensuring buy-in from GPs

15. Conclusions (1/2) Financial sustainability of healthcare delivery
Encouraging news as social prescribing can help with:
Financial sustainability of healthcare delivery
Promoting a different relationship between people and their environment
Supporting the growth of resilient communities (through voluntary sector and social connections)
Promoting integration between health and social care
However, in practice much more difficult:
The NHS has made steps in this direction but specific funding is not yet available at national level
Despite rhetoric, prevention is still a very small proportion of overall expenditure.
Five year forward view, GP forward view!!

16. For more information: Dr Marcello Bertotti m.bertotti@uel.ac.uk
Thanks for listening
For more information: Dr Marcello Bertotti

17. Bickerdike, L et al (2017) ‘Social prescribing: less rhetoric and more reality. A Systematic review of the evidence’, BMJ open, 7, 2-18
Citizen’s Advice (2016) A very general practice: How much time do GPs spend on issues other than health? tizensAdvice/Public%20services%20publicatio ns/CitizensAdvice_AVeryGeneralPractice_May 2015.pdf
Polley, M (2018)”Review of our strategy.Social prescribin Network Strategy Meeting”, 11th Jan 2018
Polley, M et al (2017) ’A review of the evidence assessing impact of social prescribing on healthcare demand and cost implications’, University of Westminster
References