I’ve been really pleased to see a growing enthusiasm within the NHS for social prescribing. In terms of preventing ill health and improving wellbeing, it is essential that we make better use of the people and resources that already exist in our communities. Moving away from defining all problems as medical will help earlier support for people and, hopefully, reduce the need for reactive services once issues have developed into long term conditions.
Putting in place a model of social prescribing is obviously not without challenges. In the early stages the most significant barriers are for prescribers to know what is available in a community. It is all too easy to fall back on the same old faces from the voluntary sector that already provide commissioned services. The real value of social prescribing is when you make links with the wider community groups that might not realise the benefits they provide to their members. This is about finding fishing clubs, finding book clubs and knowing about running clubs. It’s about knowing the assets in your community.
Once you’ve got an understanding of what’s in your community there is a significant engagement challenge in talking to those groups and agreeing how prescribing would work for them. Are they prepared for people to turn up? What support will be there for people that might lack confidence to join new groups? What impact will social prescribing have on the existing members of the groups? This can be a long conversation and needs the people doing the prescribing to have a good understanding of what the groups they are working with do.
There are two models of the community groups that people might get referred to. Those that are directly commissioned to provide community services, these could be things like cooking classes, fitness classes etc. They receive some sort of payment from the public sector, this could be in terms of actual money or payment in kind through use of space. The other groups are spontaneous community groups that have come together because they’ve identified and filled a need. These groups are likely to be the most sustainable in the long term and the ones that will require the most engagement.
Equally the existing community groups are the least likely to want to get involved with structured measurement of impact and outcomes.
I can give you a practical example of this. In my spare time I run a ukulele group. Similar to groups that exist in pretty well every town in the UK. We are a group of about forty people that meet up every fortnight to sing and play songs. Over the years I’ve met hundreds of people that have come to the group and talked to them about the benefits they have received. They range from reducing social isolation through to building friendship groups, to building confidence singing in front of people. This is without the evidenced benefits that singing provides in terms of improved cardiovascular health and mental health. You would be hard pushed to find a medical intervention that can achieve that range of benefits.
We would be quite happy for any community navigator or social prescriber to send people to join us. We do not need any sort of payment for people to attend but equally we have no interest in measuring any of the sort of activity or outcome indicators that people who commission services normally require.
This poses a long term challenge to social prescribing models. Who owns those outcomes? In our work supporting organisations to demonstrate impact the most common question I am asked is “how can we prove we made that outcome happen?”
The simple answer is that as organisations and agencies increasingly work together with individuals, they might not be able to prove that direct causality. As organisations begin to work with community groups on social prescribing that direct line of causality will be much harder to demonstrate. Simply because the groups that can provide the most profound health and wellbeing benefits may have little or no interest in recording the benefits being achieved.
As people receive a range of help and support from disparate services it will be more important that someone is monitoring the individual at the centre of those services. Someone who is recording how the risks and protective factors they present with are being managed or removed. This method might mean we do not know the exact contribution one service is making to an outcome but we do know whether or not the individual is benefiting.
The move away from a very compartmentalised, service specific model of contract management is a sign of a mature system that is comfortable with the contribution all partners make. This move is needed to put the individual at the centre of the services that are being commissioned.