View
1
Download
0
Category
Preview:
Citation preview
Draft v0.1
Social Prescribing
A Scoping Study for North Lanarkshire
Prepared by H. McIntosh
June 2020
1
Draft v0.1
Contents
Executive summary 5
SECTION 1. Introduction 6
1.1 Purpose 6
1.2 Methods 6
1.3 Structure of this report 7
SECTION 2. The contextual landscape in North Lanarkshire 8
2.1 Demographics and health challenges 8
2.1.1 Population 8
2.1.2 Deprivation 8
2.1.3 Health inequalities 11
2.2 Strategic direction 16
SECTION 3. Social prescribing 24
3.1 Defining social prescribing 24
3.1.1 What is social prescribing? 24
3.1.2 Who is social prescribing for? 26
3.1.3 What does social prescribing offer? 27
3.1.4 How is social prescribing delivered? 29
3.2 Evidence base for social prescribing 35
3.2.1 Expectations 35
3.2.2 Benefits for people 37
3.2.3 Benefits for communities 41
3.2.4 Benefits for delivery partners 43
3.2.5 Cost and cost effectiveness 45
3.2.6 Effective principles for social prescribing 46
Section 4. North Lanarkshire’s foundations for social prescribing 51
4.1 Community and voluntary sector 51
4.1.1 Support infrastructure – Voluntary Action North Lanarkshire 51
2
Draft v0.1
4.1.2 Range of services and activities 51
4.1.3 Locator 52
4.2 Partnership working with North Lanarkshire HSCP 54
4.2.1 Community Solutions Programme 54
4.2.2 Partnership for Change 56
4.3 Social prescribing initiatives 57
4.3.1 Well Connected 57
4.3.2 Making Life Easier 58
4.3.3 SPRING Social Prescribing Project 59
4.3.4 Other link worker roles 61
4.3.5 Commissioned services 64
4.4 Stakeholder perspectives 66
4.4.1 Statutory health and care provider perspectives 66
4.4.2 Community and voluntary sector provider perspectives 77
4.4.3 Public and service user perspectives 85
Section 5. Challenges and Opportunities 87
5.1 Strategic fit 87
5.2 Creating a coordinated and strategic approach 87
5.3 Funding sustainability 87
5.4 What social prescribing means 88
5.5 Raising awareness 88
5.6 Skills and competencies 89
5.7 Target groups 90
5.8 Enabling referral 91
5.9 Workforce 92
5.10 Public engagement 93
5.11 Outcomes, monitoring and evaluation 93
5.12 Digital connectivity 94
3
Draft v0.1
5.13 Work best undertaken on a pan-Lanarkshire level 94
Section 6. Recommendations 96
References 98
AppendicesA. Informants
B. Interview and focus group guides
102
4
Draft v0.1
Executive SummaryThis scoping study was undertaken for North Lanarkshire Health and Social Care
Partnership to inform discussion around development of a framework for social prescribing.
It explored current understanding, perspectives, practice, capacity and capabilities around
social prescribing in North Lanarkshire in relation to the strategic context and supporting
evidence base for the potential benefits of social prescribing and different delivery models.
The term social prescribing is used to describe a range of approaches for connecting people
to non-medical sources of support and resources within the community to help address
needs that are largely caused by social difficulties and thereby improve their health and well-
being. These supports and resources are mostly services and activities provided by the
community and voluntary sector.
Available data on deprivation and health inequalities in North Lanarkshire shows there is a
significant need to address the social determinants that influence people’s health and
wellbeing, which expanding access to social prescribing could help to support.
There are many different delivery models for social prescribing and considerable debate
continues over the adequacy of the supporting evidence base to inform service design,
implementation, or commissioning decisions. Decisions can however be guided by
accumulated practice-based learning on effective principles.
Several social prescribing initiatives are already operating in North Lanarkshire that could be
better aligned and development of a framework presents a timely opportunity to consider
improving alignment and co-ordination in how social prescribing is currently organised and
delivered. A more aligned and strategic approach would help to ensure that social
prescribing does not develop in a fragmented way and help to position new initiatives to best
advantage.
North Lanarkshire has a large, diverse and capable community and voluntary sector and a
shared commitment to collaborative, cross-sectoral partnership working with health and
social care. Expanding social prescribing activity in the statutory sector can reasonably be
expected to result in more referrals to community and voluntary sector services. The
greatest concern identified by this study is funding insecurity within the community and
voluntary sector, which has a vital role to play in any social prescribing initiative as the main
providers of community-based services and supports and sustainable funding models have
to be in place for social prescribing to work effectively.
Other factors identified by this study that may need to be considered in developing a
framework for social prescribing are discussed.
5
Draft v0.1
SECTION 1. Introduction
1.1 Purpose
This scoping study was undertaken at the request of North Lanarkshire HSCP to inform
discussion around planned development of a framework for the implementation of effective
social prescribing across North Lanarkshire. The aim was to explore current understanding,
perspectives, practice, capacity and capabilities in relation to social prescribing in North
Lanarkshire taking account of the strategic context and wider evidence base for the potential
benefits of social prescribing and different delivery models.
1.2 Methods
The study was undertaken between October 2019 and March 2020 by a researcher
employed by the host organisation Voluntary Action North Lanarkshire. A mixed methods
approach was taken comprising:
Desk-based research to review strategy documents, published evidence reports and
other documentary and online sources.
Semi-structured individual interviews with staff occupying senior positions within Health
and Social Care North Lanarkshire and NHS Lanarkshire (selected by Kerri Todd,
Assistant Health Promotion Manager for NHS Lanarkshire).
Focus group and small group discussions with providers working in community and
voluntary sector organisations across North Lanarkshire.
Large group meeting discussions with attendees at various community and voluntary
sector network and North Lanarkshire locality events.
Initial exploration of public and service user engagement through Partnership for
Change.
Limitations: Consultation with a wider range of statutory sector providers was not possible
within the study timeframe so the perspectives of key groups including GPs and other front-
line staff have not been explored. Similarly, there was minimal engagement with service user
representatives.
6
Draft v0.1
1.3 Structure of this report
Section 1 Introduction.
Section 2 Summarises selected population demographic and health inequalities data from
existing sources and extracted information from strategic plans to illustrate the potential for
social prescribing to address current needs and the approach’s alignment with current
strategic priorities in North Lanarkshire.
Section 3 Describes how social prescribing is variously defined and summarises the
evidence base.
Section 4 Presents a narrative account of the findings from stakeholder interviews, focus
group and informal discussions. Overinterpretation has been purposely avoided which is
appropriate to the level of analysis that was possible within the study timeframe, letting the
quotations speak for themselves.
Section 5 Discusses some challenges and development opportunities for effective and
sustainable social prescribing in North Lanarkshire.
Section 6 Offers recommendations arising from the scoping study to optimise social
prescribing practice in North Lanarkshire and inform future development.
7
Draft v0.1
SECTION 2. The contextual landscape in North Lanarkshire
2.1 Demographics and health challenges
2.1.1 Population
North Lanarkshire has a population of 340,180 (2018), the fourth highest out of the 32
council areas in Scotland, having increased by 5.6% over the previous 10 years.1 Across the
six health and social care localities within North Lanarkshire the North locality has the largest
population (86,095) followed by Wishaw (58,343); Airdrie (57,576); Coatbridge (50,389);
Motherwell (45,504) and Bellshill (42,273).2 Approximately 2.1% of North Lanarkshire’s
population belong to a minority ethnic group.3
Projections based on 2016 data predict an
increase of 1% in North Lanarkshire’s
population by 2026. The average age of the
population is also projected to increase over
the same period with the largest percentage
increase (25.5%) expected in the 75 years
and over age group, continuing the aging
population trend observed between 1998 and
2018 (ibid footnote 2).
There were 151,744 households in North
Lanarkshire in 2018. Projections based on
2016 data, predict an increase of 5.3% to
158,375 by 2026. The number of ‘one adult’
households is projected to increase by 13.8% to 58,821 and remain the most common type,
accounting for 37.1% of the total; the number of one adult with dependent children
households is projected to increase by 9.3% to 13,636 (ibid footnote 2).
2.1.2 Deprivation
The Scottish Government uses the Scottish Index of Multiple Deprivation (SIMD) to identify
where in Scotland people are experiencing concentrations of deprivation.
1National Records of Scotland, North Lanarkshire Council Area Profile https://www.nrscotland.gov.uk/files/statistics/council-area-data-sheets/north-lanarkshire-council-profile.html#population_estimates2Locality profiles 2019 https://www.northlanarkshire.gov.uk/index.aspx?articleid=8881 3North Lanarkshire Equality Strategy 2019–2024 https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=23722&p=0
8
Draft v0.1
SIMD 2020 ranked North Lanarkshire as the 6th most deprived council area in the country
based on local share of the 20% most deprived data zones in Scotland:
155 (35%) of North Lanarkshire’s 447 data zones are among the 20% most deprived
nationally, an increase from 144 (32%) since SIMD 2016).4
31 (7%) of North Lanarkshire’s data zones are among the 5% most deprived in Scotland
(an increase from 29 in SIMD 2016); and there are areas of deep-rooted deprivation
where data zones have consistently been among the 5% most deprived in Scotland
since SIMD 2004.2
Five of North Lanarkshire’s data zones among the 1% most deprived in Scotland, two of
these having moved into the worst 1% since SIMD 2016.3
The SIMD comprises more than 30 indicators of deprivation grouped together into domains
that provide insight on where people are experiencing disadvantage across seven different
aspects of their lives: income, employment, health, housing, education, access to services
and crime.
Income deprivation
Fifteen percent of North Lanarkshire’s population (50,897 people) is income deprived, a
reduction of 3% from SIMD 2016 but proportionally higher than the 12% across Scotland
as a whole.
Employment deprivation
While the number of working age people experiencing employment deprivation has fallen
since SIMD 2016 it remains at 11% in North Lanarkshire compared with the national
average of 9% (ibid footnote 5) 2015 data showed 7.84% of adults in North Lanarkshire claiming incapacity benefit or
severe disablement allowance compared with the national average of 6.16%; and 9.2%
claiming pension credits compared with 6.2% nationally (ibid footnote 3).
In 2016, the percentage of children in North Lanarkshire living in low income households
varied from 4% in Balloch West and Carrickstone, Cumbernauld to 43.4% in Craigneuk,
Wishaw (ibid footnote 3); with 18.8% overall living in low Income households compared
with the national average of 16.7%.5
4North Lanarkshire Council, Scottish Index of Multiple Deprivation 2020 Briefing Note https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=23859&p=0 5https://scotland.shinyapps.io/ScotPHO_profiles_tool/
9
Draft v0.1
Housing deprivation
SIMD 2020 ranked 94 (21%) of North Lanarkshire’s data zones among the 20% most
deprived in Scotland for housing, which includes indicators for overcrowding and
absence of central heating.
Around 34% of households in North Lanarkshire are living in fuel poverty.6
Health deprivation
Areas that show income deprivation also show health deprivation.
SIMD 2020 ranked 168 (38%) of North Lanarkshire’s data zones among the 20% most
health deprived in Scotland—the largest number of data zones in that category than for
any other SIMD domain (ibid footnote 5).
Lanarkshire is the 3rd most deprived health board area in Scotland based on local share
of the 20% most deprived data zones for income and health.7
Education deprivation
SIMD 2020 ranked 162 (36%) of North Lanarkshire’s data zones among the 20% most
deprived in Scotland for education: 24 among the 1% most deprived nationally; and the
data zone ranked number 1 in Scotland for educational deprivation is in North
Lanarkshire.
Data from 2014–2015 showed that 73% of looked after children and young people in
North Lanarkshire left school aged 16 or under compared with 27% for other pupils (ibid
footnote 7).
Data from 2016–2017 showed North Lanarkshire had the highest rate of exclusion from
school for looked after children at 137.1 per 1000 pupils compared to the national
average of 79.9 per 1000.8
Access deprivation
SIMD 2020 ranked 69 (15%) of North Lanarkshire’s data zones among the 20% most
deprived in Scotland for access to services, which includes indicators for travel time to
essential services including a GP, schools, retail centres and broadband access.
Only 1% of North Lanarkshire’s population live outwith the main urban areas (ibid
footnote 7).
6North Lanarkshire Partnership - Local Outcomes Improvement Plan https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=21277&p=07Introducing the Scottish Index of Multiple Deprivation 2020 https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=23823&p=08The Plan for North Lanarkshire
10
Draft v0.1
Crime deprivation
SIMD 2020 ranked 118 (26%) of North Lanarkshire’s data zones among the 20% most
deprived nationally based on indicators of recorded crime, and five within the 1% most
deprived.
2.1.3 Health inequalities
The Lanarkshire population health profile is poorer than the national average for many
indicators including smoking attributable deaths, deaths from alcohol conditions, and
children living in poverty.9 Many risk factors for poor health are closely linked to the social,
economic, and environmental conditions in which people live (Craig & Robinson 2019;
Health Foundation 2019). The greater the gap between the least and most deprived in
relation to these social determinants of health—like income, employment, education, living
environment and social capital—the greater the differences in health (WHO).10 Such health
inequalities are associated with differences in life expectancy and healthy life expectancy
meaning that people experiencing more deprivation not only die sooner but also spend more
of their shorter lives in poor health (Health Foundation 2019).
Life expectancy
In Scotland, improvement in life expectancy has stalled since around 2012.11 It has slowed
markedly in less deprived areas while mortality has been increasing in the most deprived
areas, indicating a widening of socioeconomic and associated health inequalities (Fenton et
al 2019).
In North Lanarkshire, life expectancy at birth (2016–2018) is lower for both males (75.2
years) and females (79.6 years) compared with the national average (77.1 years and
81.1 years, respectively) (ibid footnote 2).
In 2018, ischaemic heart disease then dementia and Alzheimer’s disease were the two
leading causes of death for both men (12.9% and 7.5%, respectively) and women (8.8%
and 14.3%, respectively) overall in North Lanarkshire and in Scotland as a whole (ibid
footnote 2).
Healthy life expectancy is also lower for people living in deprived areas in Scotland than for
those living in the least deprived areas12.
9Lanarkshire Primary Care Improvement Plan 2018 10WHO Social determinants of health: the solid facts 2nd edition 2013 http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf11Stalling life expectancy is a warning light for public health in Scotland http://www.healthscotland.scot/news/2019/february/stalling-life-expectancy-is-a-warning-light-for-public-health-in-scotland12ScotPHO Healthy life expectancy: key points https://www.scotpho.org.uk/population-dynamics/healthy-life-expectancy/key-points
11
Draft v0.1
30% of people in North Lanarkshire are living with one or more long-term health
conditions (ibid footnote 4).
25% of people over the age of 16 are limited in their day to day activities either a little or
a lot compared with the national average of 23%.
Premature death from all causes among people under 75 years of age—a national headline
indicator of health inequalities—was four times higher in the most deprived areas compared
to the least deprived areas in Scotland in 2018: the largest gap observed over the previous
10 years.13 In 2018 the mortality rate among 15 to 44 year-olds—a national indicator of
inequality in mortality—was eight times higher in the most deprived areas in Scotland (273.3
per 100,000 EASR14) compared to the least deprived (36.3 per 100,000) (ibid footnote 14).
In 2016, the rate of early deaths from all causes in the 15 to 44 years age group in North
Lanarkshire was 127.8 per 100,000 population compared with 105.8 per 100,000
nationally.
Disease burden
The Scottish Burden of Disease study (2016) highlighted the need to address the public
health priorities of mental health, alcohol, tobacco, drug problems, diet, healthy weight and
physical inactivity. It showed the disease burden15 in the most deprived areas was than
double that in the least deprived areas, and that it increased with each level of increasing
deprivation.16 The largest relative inequalities were for drug use disorders, alcohol
dependence, chronic liver disease, chronic obstructive pulmonary disease (COPD) and lung
cancer. When looked at by broad disease groups, the largest differences were for mental
health and substance use disorders, chronic respiratory diseases, and suicide and self-
harm-related injuries. Below are selected pertinent data for North Lanarkshire extracted from
the Locality Profiles (2019) and other sources as referenced.
Chronic liver disease, COPD and coronary heart disease
The prevalence of chronic liver disease in North Lanarkshire is 6.0 per 1000 population
(2018–2019) having increased on an annual basis since 2014–2015.
The rate of hospitalisation with COPD is higher in North Lanarkshire than for Scotland
overall at 360 patients per 100,000 population compared with 245.8 nationally (3-year
13Long-term monitoring of health inequalities, Scottish Government 2020 https://www.gov.scot/publications/long-term-monitoring-health-inequalities-january-2020-report/14European Adjusted Standardised Rate15Disease burden is measured in disability-adjusted life years (DALYs)= years of life lost due to premature mortality (YLL) + years lived with disability (YLD)16The Scottish Burden of Disease Study, 2016 https://www.scotpho.org.uk/media/1656/sbod2016-deprivation-report-aug18.pdf
12
Draft v0.1
aggregate 2013/14 to 2015/16): local rates range from 85.7 patients per 100,000
population in Stepps in the North locality to 816.7 in Motherwell North.
All six North Lanarkshire localities show an upward trend for COPD/asthma prevalence
(2018–2019) with the highest rate of increase being in the Wishaw locality.
The rate of coronary heart disease (CHD) hospitalisations—a national morbidity
inequality indicator—is higher in North Lanarkshire than for Scotland overall at 460.5 per
100,000 population compared with 403.1 nationally (2014): local rates range from 216.3
patients per 100,000 population in Craigneuk, Airdrie to 686.5 in Petersburn, also in
Airdrie locality.
The death rate from CHD in those under the age of 75 years is higher in North
Lanarkshire than for Scotland overall at 65.92 per 100,000 population compared with
53.21 nationally (2015): local rates range from 7.82 per 100,000 population in Chapelhall
East, Airdrie to 170.65 in Kirkshaws, Coatbridge.
Alcohol and drugs
The rate of alcohol-related hospital admissions is higher in North Lanarkshire compared
with Scotland overall at 8.7 per 100,000 population compared with 6.6 nationally (2018–
19): at 12.5 per 1000 population, the rate for Coatbridge has increased by around 28%
over the last 5 years and has been consistently higher compared with North Lanarkshire
as a whole.
In 2016, alcohol-related hospital stays stood at 859.2 per 100,000 population compared
with 680.8 nationally: local rates range from 84.5 per 100,000 population in Craigneuk,
Airdrie to 2378.2 in Forgewood, Motherwell.
At 1.9 per 1000 population (2018–19) the rate of drug-related hospital admissions in
North Lanarkshire is equivalent to the national average: the rate in Motherwell (2.3
admissions per 1000) has however remained consistently higher since 2014–15; and
Coatbridge has the highest rate (2.6 per 1000 population) having increased over the last
4 years at a faster rate than in other localities.
Mental health
In Scotland in 2017, people aged 16 years and over in the most deprived areas were three
times more likely to have below average mental wellbeing—a national headline indicator of
health inequality—than those in the least deprived areas.17
In 2018–2019, 21.3% of the population of North Lanarkshire was prescribed drugs for
anxiety/depression/psychosis compared with the national average of 19.3%.18 17Long-term Monitoring of Health Inequalities 2018 file:///C:/Users/User/Downloads/00543867.pdf18 https://scotland.shinyapps.io/ScotPHO_profiles_tool/
13
Draft v0.1
In 2016, the percentage population prescribed drugs for anxiety, depression and
psychosis ranged from 13.6% in Balloch West, Cumbernauld to 28.5% in Motherwell
South.19
The prevalence of psychosis in North Lanarkshire is 23.4 per 1000 population (2018–
2019): prevalence in the North locality (16.2 per 1000) is considerably lower than the
North Lanarkshire average and has been for the previous five years whereas in
Motherwell (26.7 per 1000), Bellshill (27.0 per 1000) and Airdrie (27.3 per 1000) it has
been consistently higher; prevalence has increased most rapidly in Airdrie particularly
over the last three years.
A national survey (2002) indicated that 45% of children and young people aged 5–17 years
who are looked after by a local authority in Scotland have a health mental disorder.20 North
Lanarkshire’s local outcomes improvement plan states that looked after children are
approximately four times more likely to have a mental disorder than children living in their
birth families (data source not cited).
Maternal health
In 2015, 83.6% of babies in North Lanarkshire were of healthy birthweight—a national
indicator of inequality—similar to the national average of 83.4%. Local rates ranged from
93.4% in Seafar, North locality to 76.3% in Calderbank and Brownsburn, Airdrie (ibid
footnote 3) Breastfeeding rates varied across the six localities from a low of 2.8% in Bellshill
Central to 31.3% in Ladywell, Motherwell compared with a council average of 15.2% and a
national average of 27.1% (ibid footnote 3).
Carers
The Carers (Scotland) Act 2016 defines a carer as an individual who provides or intends to
provide care for another individual (the cared-for person) and a young carer as someone
who is under 18 years old or still at school.
Scotland's 2011 Census determined that just over 10% of North Lanarkshire’s population
(34,000 people) was providing care compared with the national average of 9.3%.
Around 1 in 12 carers in North Lanarkshire are under the age of 24 and 1 in 5 are
retired.21
The Scottish Health Survey (2012–2013) found that the proportion of people who are carers
is similar between the least and most deprived areas in Scotland, but those in the most
19North Lanarkshire Health and population indicators across the six social work localities https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=22594&p=0 20Office for National Statistics, 200421North Lanarkshire Strategy for Adult Carers and Young Carers 2019–2024 https://mars.northlanarkshire.gov.uk/egenda/images/att92598.pdf
14
Draft v0.1
deprived areas provide the most hours of caring.22 Almost half (47%) of carers living in the
most deprived areas care for 35 hours a week or more compared with a quarter (24%) of
carers living in the least deprived areas. This disparity is also apparent among young carers
(defined as aged under 25 years): young people living in the 20% most deprived areas in
Scotland are more likely to be carers than those in the least deprived areas (3.1% versus
1.7%) and more likely to care for 35 hours a week or more (28% versus 17%).
North Lanarkshire placed second out of all Local Authority areas for the intensity of care
that carers provide, ranked according to the percentage of the population providing 35
hours of care each week (ibid footnote 23).
Around 30% of carers in North Lanarkshire (10,500 people) provide care for more than
50 hours each week, equating to around 3% of the population (ibid footnote 23).
As carers with greater caring responsibilities are drawn disproportionately from more
deprived areas, caring may stem from lack of choice and unfair circumstances and be
exacerbated by these existing inequalities. Further, the more care someone provides the
less likely they are to report ‘very good’ or ‘good’ health, and this is true for different age
groups (ibid footnote 18).
The Scottish Health Survey (2012–2013) found that those caring for 35 hours a week or
more are significantly more likely to have lower wellbeing scores and experience a
psychiatric disorder than other groups of carers and non-carers. Almost 4% of young carers
had a mental health condition compared with just over 1% for non-carers; and the proportion
with a long-term condition or disability (22%) was double the rate for non-carers (11%) (ibid
footnote 18). People who care for both older relatives and dependent children are more likely
than the general population to experience symptoms of mental ill-health, such as anxiety and
depression, and struggle financially, and the prevalence of mental ill-health increases with
the amount of care given.23 A health needs survey undertaken by North Lanarkshire Carers
Together (2013-2016) identified anxiety and stress as the most common health problems for
cares, affecting 75% (899/1197) of respondents; 49% reported depression or feeling sad
and 30% experienced isolation and feeling alone.24 Almost a third of respondents (27%)
reported that the financial impact of caring was affecting their health.
2.2 Strategic direction
22Scotland's Carers 2015 https://www.gov.scot/publications/scotlands-carers/pages/1/23Office for National Statistics 2019 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/articles/morethanoneinfoursandwichcarersreportsymptomsofmentalillhealth/latest 24Carers Health Needs Report FMR Research 2017 http://www.carerstogether.org/wp-content/uploads/2017/08/NLCT-Carers-Health-Needs-Final-Report.pdf
15
Draft v0.1
The Plan for North Lanarkshire
North Lanarkshire Partnership’s (NLP) long-term strategic Plan for North Lanarkshire
recognises there are still unacceptably high levels of deprivation and child poverty within
North Lanarkshire, and clear areas of inequity and inequality including an element of social
exclusion in some towns and communities.25
The Partnership’s work towards achieving its shared ambition—what ‘We Aspire’ to achieve
—is guided by the five priorities set out in the plan:
Improve economic opportunities and outcomes.
Support all children and young people to realise their full potential.
Improve the health and wellbeing of our communities.
Enhance participation, capacity, and empowerment across our communities.
Improve North Lanarkshire's resource base
The Ambition Statements attached to these priorities convey a shared commitment to
designing services around people, communities and shared resources; improving community
involvement in service developments and decisions that affect them; and developing
communities’ capacity to help themselves; along with giving people choice over supports
and services; promoting preventative approaches, early intervention, self-management and
independence, and encouraging health and wellbeing through social, cultural, and leisure
activities.
North Lanarkshire Equality strategy
North Lanarkshire Council’s (NLC) Equality Strategy (2019–2024) recognises that the
poverty, disadvantage and inequalities that exist for some people in North Lanarkshire can
be exacerbated if they have particular characteristics.26 The Council considers its
commitment to equality as being critical to achieving the best possible outcomes for all the
people of North Lanarkshire. The strategy’s objectives include ensuring provision of local
services that are appropriate and accessible to the diverse needs of all residents and service
users.
Health and Social Care North Lanarkshire Strategic Plan
HSCNL’s ten-year strategic plan (2016–2026) has the overarching ambition to set in motion
an approach to delivering health and social care that will lead over time to achieving national
25 The Plan for North Lanarkshire https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=22960&p=026 Equality strategy https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=23722&p=0
16
Draft v0.1
outcomes for health and wellbeing; children, young people and families; and community
justice.27
The North Lanarkshire Integration Joint Board (IJB) will focus on six strategic priorities over
the lifetime of the plan:
Addressing inequalities
Prevention and early intervention
Person-centred support
Effective, safe, timely and quality care
Maximising all our assets
Making the whole system work efficiently
A three-year (2020–2023) Strategic Commissioning Plan28 sets out six Ambition Statements,
to:
Do the right thing first time
Provide a range of community services to support people to live well in connected
communities
Focus on what matters to people (outcomes)
Be at the forefront of technical and sustainable solutions
Promote prevention and early intervention
Ensure North Lanarkshire is the best place to work, volunteer and care
These ambitions were informed by the community-driven priorities that people should be in
control of the care they receive; and be supported to maintain independence, self-manage
their care needs, and avoid preventable conditions.
Goals to work towards achieving these ambitions over the coming three years include:
Increased focus on addressing inequalities, and prevention and anticipatory care
approaches
Further develop ways to ensure cross-sector service providers are accessible at the first
point of contact, the underlying principle being there should be ‘no wrong door’
Develop whole system pathways for long terms conditions management
Further develop and promote Making Life Easier
Support communities to build connections
Develop opportunities for volunteering
The locality approach to planning and delivering health and social care in North Lanarkshire
enables services to be tailored to different needs in local areas, and the assets that already
27 HSCNL Strategic Plan 2016–2026 http://www.hscnorthlan.scot/wp-content/uploads/2016/05/nlc_strat_doc_v13.pdf28 HSCNL Draft Strategic Commissioning Plan 2020–2023 https://www.hscnorthlan.scot/wp-content/uploads/2020/02/Draft-Strategic-Commissioning-Plan-20-23-for-feedback.pdf
17
Draft v0.1
exist within local communities to be taken into account in the development of local supports
and services.
Partnership working with the third sector is integral to delivering the locality approach:
accordingly, a commitment to investment in the third sector is embodied in the goal to
continue to invest in and develop the Community Solutions Programme commissioning
strategy over the coming three years. The Community Solutions Programme (formerly called
Community Capacity Building and Carer Support) is described as the third sector branch of
HSCNL. Community Solutions funds community and voluntary sector organisations to
deliver community-based services and activities that promote health and wellbeing. The
programme’s current five-year strategy (2018/23) (sic)29 and commissioning plan focus on
personal outcomes achievement for service users based on its overarching strategic
priorities to address inequalities and reduce loneliness and isolation. (Community Solutions
is described in more detail in section 4.2.1.)
HSCNL’s strategic work programme for the next three years also includes delivering
HSCNL’s Participation and Engagement Strategy, the Primary Care Improvement Plan and
the Mental Health and Wellbeing Strategy for Lanarkshire; and implementing North
Lanarkshire’s Children’s Services Plan, NHS Lanarkshire’s Child and Young People’s Health
Plan, and the Carers Act.
Participation and Engagement Strategy
HSCNL’s Participation and Engagement Strategy is a key strand of work in support of the
overall Strategic Plan. It sets out how the Partnership will ensure effective engagement with
stakeholders in the communities it serves including the third and independent sector, carers
and people who use services.30 The intention is to build on local knowledge and experience
to ensure that services are tailored to community needs and make the most of existing
community assets.
Primary Care Improvement Plan
Lanarkshire’s Primary Care Improvement Plan (PCIP) supports the delivery of the General
Medical Services (GMS) contract (2018) that aims to refocus the role of GPs as expert
medical generalists working with a wider team to provide more healthcare in the community
and ensure that people are seen by the right person, in the right place, at the right time.31
29 North Lanarkshire Community Capacity Building and Carer Support Strategy 2018/2330 HSCNL Participation and Engagement Strategy 2017–2020 https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=20509&p=031 Lanarkshire Primary Care Improvement Plan (PCIP) GMS Contract 2018 https://www.nhslanarkshire.scot.nhs.uk/download/primary-care-improvement-plan/?wpdmdl=6482&ind=1565002490589
18
Draft v0.1
The Plan recognises the need to address health inequalities in Lanarkshire and the key role
of primary care services in improving health and wellbeing for individuals in local
communities through actions that include referral and signposting to a range of social
supports that can facilitate changes in life circumstances and lifestyles, and help build
community resilience
GP Community Link Workers (CLW) is one of the six key priorities that GP practices or
clusters will deliver for patients under the new GP contract. Recruitment of nine CLWs to
work within GP surgeries across North Lanarkshire was underway at the time of writing. (GP
Community Link Workers is described in more detail in section 4.3.4.)
Mental Health and Wellbeing Strategy
Lanarkshire’s Mental Health and Wellbeing Strategy (2019-2024) acknowledges that mental
health outcomes are not distributed evenly across the population: and that recognition of the
strong relationship between social inequalities and poor mental health together with
collaborative working across organisational boundaries will be required to achieve its vision
for a Lanarkshire where everyone can have good mental wellbeing.32
Outcome-focused action plans for North Lanarkshire and South Lanarkshire have an
overarching focus on reducing inequalities. Within these plans there are actions around
development and accessibility of community assets and non-clinical sources of support;
providing support for people who face barriers to accessing community supports; building
capacity within the third sector; and harnessing the contribution of the community and
voluntary sectors to bring in additional resources. Promoting early intervention and
maximising community assets through the development of a social prescribing framework for
young people is among the actions for delivering on mental health and wellbeing in this
population, possibly through extending the Well Connected model. (Well Connected is
described in more detail in section 4.3.1.)
Children’s Services and Children and Young People’s Health plans
Children’s Services and Children and Young People’s Health plans are currently being
developed (as noted in HSCNL’s Strategic Commissioning Plan for 2020–2023).
NLP’s Children’s Services Plan for 2017–2020 set out the outcomes that North Lanarkshire
Children’s Services Partnership planned to deliver for children, young people and families,
32 Getting it Right for Every Person (GIRFEP) A Mental Health and Wellbeing Strategy for Lanarkshire (2019–24) https://www.nhslanarkshire.scot.nhs.uk/download/mental-health-wellbeing-strategy-2019-2024/
19
Draft v0.1
which included outcomes around prevention, and promoting mental health, wellbeing and
resilience.33
Recognition that statutory, independent and voluntary sector agencies working with children,
young people and families can deliver more by working in partnership than by working alone
was central to the development of Lanarkshire’s Children and Young People’s Health Plan
for 2018–2020.34 The plan set out overarching aims to focus on reducing health inequalities
through prevention, early intervention and partnership working; improve health and wellbeing
outcomes by supporting children and young people to adopt healthier lifestyles; improve
outcomes and experiences for children and young people with additional support needs; and
build solutions with and around this population to ensure they are central to decisions that
affect their health and wellbeing.
North Lanarkshire Strategy for Adult and Young Carers
North Lanarkshire’s strategy for adult and young carers (2019–2024) sets out the plan of
action for implementing statutory duties under the Carers (Scotland) Act 2016.35
HSCNL has taken the approach of commissioning local third sector carer organisations to
deliver a range of community-based support services for unpaid adult and young carers in
North Lanarkshire. In 2019, the contract to deliver these services was awarded to three
organisations:
Lanarkshire Carers Centre—direct support for adult carers
Action for Children—Young Carer’s Support Service
North Lanarkshire Carers Together—adult carers campaigning, information and
representation Services
The contract was awarded for an initial period of four years with an option to extend for two
years and a further one year.
The strategy’s action plan for adult carers includes enabling primary and community health
staff to identify and signpost carers to suitable community supports, and encouraging carer
participation in community-based activities, leisure and employment opportunities so that
carers can establish connections and supports to enhance their lives, have the same choice
33 North Lanarkshire Partnership Children’s Services Plan April 2017–March 2020 https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=20987&p=0 34 Children and Young People’s Health Plan Lanarkshire 2018-2020 https://www.nhslanarkshire.scot.nhs.uk/download/child-and-young-peoples-health-plan-2018-2020/?wpdmdl=6757&ind=156767258935335 North Lanarkshire strategy for adult and young carers 2019–2024 https://mars.northlanarkshire.gov.uk/egenda/images/att92598.pdf
20
Draft v0.1
and control as any other citizen, and feel less isolated and more able to continue in their
caring role.
Actions for young carers include supporting young people to overcome barriers to accessing
social, sporting and cultural activities, and signposting young carers and their families to
other organisations within the third sector so that young carers are enabled to have a normal
social life and fulfil their potential, and feel better about themselves and experience less
stress and isolation.
Community and Voluntary Sector Strategy for North Lanarkshire
The objectives within North Lanarkshire’s Community and Voluntary Sector Strategic Plan
(2020–2023) include strengthening communication and collaboration within the sector, its
partnership engagement, and the sustainability of its resource base to ensure the sector is
able to respond effectively to local needs.36
Voluntary Action North Lanarkshire (VANL), the third sector interface for the North
Lanarkshire local authority area has developed a linked organisational strategic plan aligned
to this whole sector strategy. Both this strategy and VANL’s linked strategic plan have been
developed in response to identified community and voluntary sector’s priorities and support
needs in North Lanarkshire.
Voluntary Action North Lanarkshire Strategic Plan
VANL’s strategic plan for 2020–2023 sets out how the organisation will support the
community and voluntary sector in North Lanarkshire in line with its mission to foster
dynamic, inclusive communities through promoting and supporting volunteering and
development of the voluntary and community sector in order to improve quality of life and
wellbeing for the people of North Lanarkshire.37
The focus of the plan’s objectives is to help the sector fulfil its resource requirements, and
provide guidance, support and training on organisational development priorities, so that it is
better able to respond more effectively to local needs; support effective communication and
collaboration across sectors and with local citizens; and support the sector’s contribution to
delivering the Plan for North Lanarkshire.
The ways in which these objectives will be met include supporting community and voluntary
sector organisations to diversify their sources of income; promoting volunteering and
employer-supported volunteering; working with the sector and statutory partners to improve
36 Community and Voluntary Sector Strategy for North Lanarkshire April 2020–March 2023 (Draft three)37 Voluntary Action North Lanarkshire Strategic Plan 2020—2023
21
Draft v0.1
support for the community and voluntary sector paid and volunteer workforce, local grant
funding, procurement and access to community resources.
VANL receives core funding to deliver this plan from North Lanarkshire Council and has
recently agreed a three-year Service Level Agreement with the Council, although the level of
continued funding may change depending on the Council’s financial situation.
Community and Voluntary Sector Children and Young People’s Strategy
North Lanarkshire’s Community and Voluntary Sector Children, Young People and Families
Strategy (2020–2023) sets out how the sector will work collectively and with the public sector
and business sector to improve the lives of children, young people and families in North
Lanarkshire.38 In so doing, the strategy aims to contribute to the achievement of the
ambitions and intended outcomes of other key partnership strategies including the Children’s
Services Plan and Child and Young People’s Health Plan, the Community Solutions
Strategy, Lanarkshire’s Mental Health and Wellbeing Strategy, and the Plan for North
Lanarkshire.
The Strategy’s objectives are to support the sector to improve the effectiveness of its
services and support for children, young people and families, inform and influence relevant
wider policies and services, and evaluate and communicate more effectively the contribution
it makes to improving peoples’ lives; and to strengthen understanding and appreciation of
the sector’s contribution within the statutory sector and more widely.
The ways in which these objectives will be met include strengthening the design and delivery
of community and voluntary sector support and services through user engagement, sharing
of information and training; governance, organisational development and workforce (paid
and voluntary) development support; and facilitating innovation and piloting new approaches.
38 North Lanarkshire Community and Voluntary Sector Children, Young People and Families Strategy 2020–2023 (Draft 5)
22
Draft v0.1
Section 3. Social prescribing
3.1 Defining social prescribing
3.1.1 What is social prescribing?
The term social prescribing is used to describe a range of approaches for connecting people
to non-medical sources of support and resources within the community to help address
needs that are largely caused by social difficulties and thereby improve their health and well-
being.
The rationale for social prescribing lies in the longstanding recognition that addressing the
social determinants that influence people’s health and their ability to live healthier, happier
lives is just as important as providing good healthcare. And that this requires solutions that
have their basis in the social model of health with its focus on promoting wellness rather than
the healthcare-oriented medical model with its emphasis on illness and treatment.
The supports and resources that social prescribing connects people to are generally,
although not exclusively, services and activities provided by the community and voluntary
sector that have a positive influence on wellbeing. Social prescribing, therefore, aims to
complement, rather than replace, mainstream healthcare provision by harnessing strengths
and assets within the community that are better able to address people’s social, emotional
and practical needs (Paterson 2019, Davison et al 2019, Year of Care 2011).
Initiatives described as social prescribing range from simply making information about
community-based resources generally available to people, through progressive levels of
individualised signposting and supported referral, to provision of one-to-one support,
possibly from a dedicated link worker, for people who need more help to access what they
need. The schematic shown in Figure 1, which was used in a survey to gather information in
order to map social prescribing activity in Dundee, illustrates this conceptualisation of social
prescribing as a spectrum of approaches.
Figure 1. Social Prescribing as a spectrum of approaches: mapping activity in Dundee39
39 Dundee Strategic Social Prescribing Group 2019, https://www.dundeecity.gov.uk/sites/default/files/publications/socialprescribingsurveyreport-april2019.pdf
23
Draft v0.1
Consequently, the term social prescribing is often used interchangeably with terms like
signposting, community referral and link working depending on how it is understood and put
into practice (Health Scotland 2016, Drinkwater et al 2019). Others however stress that
social prescribing is more than a process of signposting and referral to community provision
because a vital aspect of social prescribing is the ongoing support and engagement that
people receive while taking part in it (Paterson 2019). Some go as far as to assert that
signposting is not social prescribing (Elemental 2018) or that it complements social
prescribing and should be viewed in terms of ‘as well as’ and not ‘instead of’ social
prescribing (NHS England 2019).
Language and meaning
The term ‘social prescribing’ is well-established particularly in the heath sector and in use
nationally in Scotland but it is not universally well liked or understood (Dundee Strategic
Social Prescribing Group 2019, Elemental 2018). The term has been described as an
oxymoron with its medicalised language of prescribing placing the person in the role of
patient or passive recipient contradicting the approach’s core principles of individual
engagement, choice and control (Davison et al 2019, Health Scotland 2016, Health
Education England 2016). Some feel that this language, therefore, does not easily support a
rebalancing of the relationship between patients and healthcare providers, and that talking
about a ‘prescription’ might constrain what a social prescribing service can provide (Dundee
Strategic Social Prescribing Group 2019, Davison et al 2019, Health Scotland 2016, Health
Education England 2016). Others, on the other hand, feel that ‘prescribing’ lends weight to
the credibility of the approach as having clinical value and could support compliance (sic)
(Dundee Strategic Social Prescribing Group 2019, Davison et al 2019). There is anecdotal
evidence that for social workers the term social prescribing can be especially objectionable
and misunderstood to undermine the social work profession.40
How the term ‘prescription’ is understood in the context of social prescribing also varies: for
some it is the healthcare or other professional who issues the social prescription through the
act of signposting or referral either directly to a community-based service or to an
intermediary link worker (Drinkwater et al 2019, Paterson 2019, Volunteer Scotland 2015,
Langford et al 2013) whereas others, including the UK Social Prescribing Network41
emphasise that it is the individual who decides, possibly with support from a link worker,
which services or activities can improve their personal situation and thereby designs their
own social prescription (Davison et al 2019).
40 Social prescribing - use what you have: Social Workers BMJ Open 2019 https://www.bmj.com/content/364/bmj.l1285/rr-0 41 https://www.socialprescribingnetwork.com/
24
Draft v0.1
Branding
Many social prescribing initiatives purposely eschew this terminology in favour of branding
local delivery using language that is more accessible to the community (Moffatt et al 2017)
such as Healthy Connections, in Dumfries and Galloway—where community engagement
informed the service brand and marketing (Claire Thirwall, Health and Wellbeing Specialist,
Dumfries and Galloway Council, Personal Communication, 20 Feb 2020). Some of the many
other examples are: Community Connect (Bexley), Ways to Wellness (Newcastle upon
Tyne), Connect Well (Essex), and indeed, Well Connected in Lanarkshire (see section
4.3.1).
3.1.2 Who is social prescribing for?
Social prescribing can support people experiencing a wide range of social, emotional, and
practical difficulties that affect their health and wellbeing. It may be used to enable people to
self-manage existing health conditions or find solutions to practical problems; or, as a
preventive approach to promoting wellness through, for example, helping people to make
lifestyle changes, build social networks, increase self-efficacy and strengthen resilience
(NHS England 2019, King’s Fund 2017, Langford et al 2013, Davison et al 2019, Kinsella
2015).
Some social prescribing initiatives target specific groups such as people experiencing mild to
moderate mental health problems or people living with long-term conditions such as
diabetes; some proactively seek out prospective service users such as ‘hard to reach’
groups or ‘high resource use’ individuals. Many initiatives have been set-up to serve
deprived communities most affected by health inequalities. If social prescribing is to help
tackle health inequalities it needs to be accessible and its interventions relevant to people
experiencing greatest social and economic disadvantage; and also to recognise that those
who may need it most may be the hardest to engage (ERS 2013, Liverpool CCG 2017,
Health Scotland 2016).
Commonly identified groups who could benefit from social prescribing include:
people with poor mental health
people living with long-term physical illness
people who are socially isolated or lonely
people experiencing social welfare problems
people who have complex social needs
people who frequently attend primary or secondary healthcare services
people not benefiting from clinical treatment or whose condition has no medical solution
people seeking ways to take greater control of their own health and happiness.
25
Draft v0.1
Children, young people and families
Most work around social prescribing to date has concentrated on adults (Hayes et al 2020).
Consideration of social prescribing for children and young people is a more recent
development and grouping this population with adults and the elderly when designing and
implementing social prescribing could be a barrier to success (Healthy London Partnership
2018, Jani et al 2019). A recent survey undertaken by the Healthy London Partnership as
part of a coproduction exercise to develop social prescribing for children, young people and
their parents and carers (Healthy London Partnership 2018) identified the following issues
that respondents most wanted support with:
Children and young people Parents and carers Coping with stress and anxiety
Sex and relationships
Exercise
Sleep
Long-term conditions
Coping with stress and anxiety
Education
Child behaviour
Self-confidence and self-esteem
3.1.3 What does social prescribing offer?
Social prescribing can offer a wide range of interventions that can help address many kinds
of non-clinical problems that affect health and wellbeing (Public Health England 2019,
Drinkwater et al 2019, Health Scotland 2016, Kinsella 2015, Volunteer Scotland 2015).
Mostly these are services and activities that local community and voluntary sector
organisations and community groups offer, usually at low or no cost to the individual. The
types of support that can be offered will, therefore, depend on what is available within a local
community.
As with all local services, what social prescribing initiatives offer should reflect the needs of
the community they serve, meaning that this may look different in each local community
(Public Health England 2019, Elemental 2018). Also, as a person-centred approach that
aims to give people a choice in which interventions can improve their personal situation,
social prescribing ideally has to offer a diverse range of options.
Interventions commonly associated with social prescribing are often grouped under broad
categories like these:
Physical activity and leisure (such as exercise classes, walking groups, ‘green gyms’)
Arts and culture (such as art classes, bibliotherapy, choirs)
Healthy eating (such as cookery classes)
26
Draft v0.1
Befriending and peer-support (such as local volunteer-led schemes)
Learning (such as digital literacy sessions and self-help resources)
Employment (such as job coaching)
Volunteering (such as volunteering to help run a community group activity)
Welfare rights (such as debt and housing advice and advocacy services).
Social prescribing initiatives designed to help specific target groups may encourage the
uptake of certain interventions that have been shown to be effective in addressing problems
that those groups often encounter.
Categorisation of social prescribing interventions according to a hierarchy of need, as
illustrated in Figure 2, illustrates that people’s basic needs—like safety, financial security and
housing—need to be addressed before other interventions targeting physical activity,
connectedness or creativity can be expected to work. (UCL Laws 2017)
Figure 2. Categories of local community services in social prescribing (Elemental 2018)
3.1.4 How is social prescribing delivered?
There is no universal agreement on the operational definition of social prescribing, and it can
mean different things to different people (Polley et al 2017b, Kinsella 2015). There are,
therefore, many different models for the delivery of social prescribing that vary in their
setting, the people they serve, the way they connect people to sources of support, the
supports on offer, the intensity and duration of support provided, and the intended outcomes
(Husk et al 2019, Drinkwater et al 2019, Health Scotland 2016). There is, therefore, no ‘one
size fits all’ model for social prescribing and variation in how it is delivered can reflect ‘fit’
according to needs and availability of community-based supports, which is locally different.
(Husk et al 2019, Health Education England 2016).
NHS Lanarkshire – a stepped model Health Scotland’s guidance on social prescribing for mental health featured a conceptual
stepped model for the delivery of social prescribing, as shown in Figure 3, as an example of
27
Draft v0.1
how NHS Lanarkshire had identified different levels of support for different client groups (sic)
dependent on need (Health Scotland 2016). This model recognises that the most suitable
level of support will depend on the complexity of need in the target group, and that each
individual will have different support needs and their level of need may change over time.
Individuals can, therefore, move between the tiers in this model: some people will require
minimal support to access the services and advice they need, for example, while others who
need high or medium level support to engage with social prescribing opportunities initially
may subsequently require lower level support to sustain their engagement and achieve their
longer-term goals.
Figure 3. Conceptual
model of delivery for social
prescribing, NHS
Lanarkshire 201542
Ways of connecting people to sources of support
Models of delivery for social prescribing generally incorporate processes of signposting and
referral to connect people to community-based sources of support. As these terms are often
used interchangeably it is useful to note the advice that referral should not be confused with
signposting, which is when a person is provided with information about another service and
has to initiate contact themselves, whereas a referral is a request from one part of a system
to another part of the system on behalf of the person (Polley et al 2017b).
Signposting
Social prescribing as signposting only may do little more than inform people of local sources
of support that might help them to address their wellbeing needs, leaving them to their own
devices to contact and engage with the services available (Kimberlee 2015). More
comprehensive models can however incorporate signposting and active signposting to
mutually agreed sources of support for those who are confident and skilled enough to find
their own way to services after a brief intervention, as in the stepped model shown in Figure
3.
42 Source: Social prescribing for mental health: guidance paper, Health Scotland 2016
28
Draft v0.1
Referral pathways
Referral is a key element of most delivery models for social prescribing and common among
these are models designed as a means of enabling GPs and other primary care
professionals to refer patients to local, non-clinical sources of support (King’s Fund 2017,
CordisBright 2019, Public Health Wales 2018, Paterson 2019). Depending on the model, this
can be a direct referral to a community-based provider or referral to an intermediary link
worker. Delivery models can incorporate referral from other agencies: NHS England, for
example, defines social prescribing as enabling all local agencies including general practice,
local authorities, pharmacies, multi-disciplinary teams, hospital discharge teams, allied
health professionals, fire service, police, job centres, social care services, housing
associations and voluntary, community and social enterprise organisations to refer people to
a link worker (NHS England 2019). Some delivery models also accommodate self-referral
and referrals from carers or family (NHS England 2019, Paterson 2019, Davison et al 2019).
Referral pathways can also extend to referrals between community-based providers and
referrals back to statutory care providers when an individual’s identified needs require it
(CordisBright 2019).
Link worker models connecting communities and healthcare services
In the context of healthcare, connecting people to community-based supports through a link
worker has emerged as a core delivery model for social prescribing and the link worker role
is widely considered to be essential to success (CordisBright 2019, Polley et al 2017b,
Davison et al 2019, King’s Fund 2017, Elemental 2018, Year of Care 2011). The UK and
Ireland Social Prescribing Network, for example, specifically defines social prescribing as a
means of enabling GPs and other frontline healthcare professionals to refer patients to a link
worker who provides them with a face-to-face conversation during which they can learn
about opportunities to improve their health and wellbeing.43
A link worker is a non-clinically trained person whose role is to enable and support
individuals to assess their needs, co-produce solutions, and connect them with suitable local
services and activities that can improve their health, wellbeing or personal situation (Polley
et al 2017b, Davison et al 2019, Bertotti et al 2019). The link worker role is designated by
various titles such as community connector, community navigator, care navigator,
community care co-ordinator, social prescribing coordinator or simply social prescriber. This
role requires relationship building to create a genuine partnership with the people they
support and engage with referring professionals and local community-based providers,
43 https://www.socialprescribingnetwork.com/
29
Draft v0.1
hence link workers are generally recruited for their communication skills, empathy and ability
to support people (NHS England 2019).
Link worker models largely embody a holistic approach to social prescribing in which the link
worker engages with an individual for as long as is necessary to fully understand their
needs, help them design solutions, support them through engagement with suitable local
services and activities and review their progress towards improvement in wellbeing
(Kimberlee 2015, Polley et al 2017b, CordisBright 2019). A key aspect is that the link worker
has more time to spend with individuals than say the typical ten minute GP appointment,
which means that people are given time to talk in detail about their situation and what
matters to them and time to develop the trust necessary to do so. The level and duration of
engagement with the link worker will vary depending on an individual’s support needs,
confidence and capacity to act independently.
In practice, social prescribing initiatives operating on a link worker model may offer
individuals a set number of one-to-one sessions initially, typically between 6 and 12, and can
provide open-ended support, continuing to work with individuals for two years of more (NHS
England 2019, Moffatt et al 2017).
There are two distinct types of link worker model according to whether the link worker is
situated within a healthcare or community and voluntary sector organisation. The former is
exemplified by the Scottish Government funded Community Link Worker programme
currently being implemented through the new GP contract in which link workers are being
situated within GP practices. As described in Section 4.3.4 of this report, the specifics of that
delivery model will be designed locally to suit local need, demand and resources. Some of
the claimed advantages of basing link workers in a healthcare setting are that it allows
healthcare professionals who would be referrers to get to know the facilitator and better
understand what their role is and that it gives a visual reminder to make referrals; and that
the visible association with the health sector adds credibility, creating trust among staff and
patients that supports initial engagement with service users (Davison et al 2019, EVOC
2017).
The SPRING Social Prescribing Project, described in section 4.3.3, currently being delivered
in North Lanarkshire is an example of a delivery model where the link workers situated within
local community ‘anchor’ organisations receive referrals from local GP practices. Link
workers being an integral part of a community-led anchor organisation is considered critical
to the project’s success because it ensures they are well linked-in to community provision
and have the support of an experienced organisation that is trusted and respected locally.
30
Draft v0.1
Ways to Wellness in Newcastle-upon-Tyne,
described as one of the first initiatives to deliver
social prescribing on a large and prolonged scale
in the UK, is another example.44 The Ways to
Wellness ‘hub’ delivery model that enables GP
practices to refer patients to link workers situated
within community organisations was designed
following extensive consultation with patients and
healthcare professionals (Moffatt et al 2017) In this
model, illustrated in Figure 4, a community
organisation or Lead Non-traditional Provider
(NTP) in each locality receives referrals and
develops relationships with other local NTPs who
provide services and activities that can meet
referred individuals’ needs and preferences,
allowing for variability in each locality (Year of
Care 2011).
The model also explicitly recognises that public
access to NTPs continues to exist alongside
additional referrals from social prescribing.
Funding models
Funding for social prescribing in the UK has come from a wide range of public, private and
third sector sources, including Clinical Commissioning Groups (in England), primary care,
public health, local authorities and charitable funders notably the National Lottery
Community Fund (Polley et al 2017b, Jani et al 2020, Paterson 2019, CordisBright 2019).
The models deployed are context dependent and there is no ‘one size fits all’ (Jani et al
2020). In the case of link worker models, where a link worker is based is not always
indicative of who employs them or how their position is funded (Polley et al 2017b).
Learning from National Community Fund funded initiatives highlighted the need for a
systematic approach to funding that nurtures and enables collaboration between statutory
and community providers: that social prescribing works best when organisations are willing
to work with each other towards shared goals and funding does not create perverse
incentives and competition (Davison et al 2019). The approach should also ensure that
44 https://waystowellness.org.uk/
31
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Figure 4. Ways to Wellness delivery model (two NTPs are shown for illustration—there can be many)
Draft v0.1
money reaches all parts of the system so the volume of demand is not simply transferred
from healthcare to the voluntary sector.
The recent Scottish Government Health and Sport Committee inquiry into social prescribing
in relation to physical activity noted that although the services to which health professionals
refer patients are nearly always provided by the community and voluntary sector, social
prescribing schemes do not fund those services or offer resource to help with their capacity
to deliver what is required.45 The Committee recommended that social prescriptions are
treated on an equal basis to medical prescriptions when issued by health and social care
professionals—a recommendation Scottish Government is supportive of in principle but
remains to be explored.46
NHS England has suggested different ways that local commissioners there can provide
funding to ensure that local voluntary organisations, community groups and social
enterprises are locally sustainable and can plan ahead, such as: developing a shared
investment fund bringing together all local partners including the private sector;
commissioning existing staffed community and voluntary sector organisations and providing
small grants for volunteer-led community groups; micro-commissioning new groups where
there are gaps in community provision; enabling people to use personal health budgets to
pay for community and voluntary sector supports; and exploring social investment
opportunities and outcome-based commissioning (NHS England 2019).
45 Social Prescribing: physical activity is an investment not a cost. Heath and Sport Committee 2019 https://sp-bpr-en-prod-cdnep.azureedge.net/published/HS/2019/12/4/Social-Prescribing--physical-activity-is-an-investment--not-a-cost/HSS052019R14.pdf46https://www.parliament.scot/S5_HealthandSportCommittee/General%20Documents/ 20200204_HS_Ltr_IN_CabSec.pdf
32
Draft v0.1
3.2 Evidence base for social prescribing
3.2.1 Expectations
The concept of social prescribing is not new but there is renewed interest in its potential to
contribute to national health and wellbeing and support delivery on a range of strategic
agendas around health and social care integration, population health and health inequalities.
Social prescribing has become part of the wider agenda of shifting the balance of care from
hospitals and GP practices towards community-based interventions more aligned to the
social model of health (Paterson 2019, Davison et al 2019). Social prescribing recognises
that the community and voluntary sector can be a largely untapped asset that can deliver
further integration between health and social care in the creation of a more responsive and
efficient local health economy.
Interest in social prescribing within the NHS has gathered pace in recent years due to
increasing demands on healthcare services and the cost implications for service provision;
as well as the growing recognition that statutory healthcare providers are unable to address
many of the social reasons why people seek help from the NHS (Polley et al 2017b, Popay
et al 2007). Social prescribing is particularly seen as a way to extend the range of options
available to GPs and other primary care practitioners to provide individualised care for
people whose needs are related to social difficulties (Polley et al 2017b, Brandling & House
2009). Primary care is for most people their most frequent point of contact with the NHS and
around 20% of patients in the UK consult their GP for what are primarily social problems. An
estimated 30% of GP consultations and half of regular attendances are for common mental
health problems, mainly stress, anxiety and depression, and many of these consultations
arise because of social difficulties including financial and debt problems, housing problems,
unemployment and loneliness (Kinsella 2015). Within Lanarkshire there is an immediate
challenge around the sustainability of several GP practices as well as a wider issue of
general sustainability.47
The potential to reduce demand on secondary care services also appears to be an important
driver of interest in social prescribing as a means of addressing inequalities and enabling
more people to manage their own health and live well over the longer term (King’s Fund
2017). People living in the most deprived areas in Scotland, for example, can account for
twice as many emergency department attendances than those in the least deprived areas,
which could be for a number of reasons including poorer health and more complex social
47 Lanarkshire Primary Care Improvement Plan GMS Contract 2018 https://www.nhslanarkshire.scot.nhs.uk/download/primary-care-improvement-plan/?wpdmdl=6482&ind=1565002490589
33
Draft v0.1
needs; and the likelihood of hospital admission following emergency department attendance
also increases with deprivation.48
It is anticipated that shifting the balance of care towards community-based interventions
more aligned to the social model of health will lead to less and more cost-effective use of
NHS and social care resources. The patient pathways for people with long-term conditions
shown in Figure 5 illustrates this conceptual association between such a shift in balance
towards enabling self-care with support from community and voluntary sector providers and
reductions in the cost of NHS care (Year of Care 2011). This schematic underpins the Ways
of Wellness social prescribing link worker model described in section 3.1.4.
Figure 5. Pathways
between medical and
social models of health for
people with long term
conditions (Year of Care
2011)
There is an expectation that cross-sectoral working to deliver social prescribing will
strengthen connections between mainstream services and community resources, help
identify and address gaps in local services and thereby lead to widening of the local provider
base.
Consequently, the anticipated benefits from social prescribing encompass a wide range of
improved outcomes for individuals, communities, service providers and the health and social
care system as a whole.
48 Understanding emergency care in NHS Scotland NHS NSS ISD 2015 https://www.isdscotland.org/Health-Topics/Emergency-Care/Publications/2015-09-29/2015-09-29-EmergencyCare-Report.pdf?597780943
34
Draft v0.1
3.2.2 Benefits for people
Non-clinical interventions
Many studies reporting on the benefits of social prescribing for people assess particular
types of non-clinical interventions commonly accessed through social prescribing, such as
physical exercise or the arts, rather than delivery models or particular approaches to social
prescribing (CordisBright 2019, Paterson 2019). Most of these studies report positive
outcomes for participants no matter what the intervention is, including self-reported
increases in motivation, confidence, self-esteem, and feelings of control; improvements in
physical and mental wellbeing and quality of life; and reductions in social isolation and
feelings of loneliness over the shorter-term (Fancourt & Finn 2019, Chatterjee et al 2018,
Price et al 2017). Evidence of lasting effects is sparse because such data are rarely
collected. The concern for those looking to implement evidence-based practice in promoting
certain types of interventions over others is that the quality of many of these studies is
questionable and publication bias49 highly likely; which, together with the wide variety of
interventions, participants and reasons for referral across studies, makes it difficult to draw
clear conclusions about effectiveness or who could benefit most or from which types of
interventions. It has to be borne in mind also that social prescribing as a person-centred
approach is about giving people choice to decide what which services or activities can
improve their own personal situation.
Evidence from studies of particular support services or activities interventions also provide
no insight on the effectiveness of social prescribing as a systems approach.
Link worker models
Studies of social prescribing delivered through link worker initiatives in the UK involving
referral from primary care have reported improvements in patient outcomes including
knowledge, skills and confidence in managing their own health, quality of life, and measures
of emotional, mental and general wellbeing. Reviews of such studies however have failed to
reach firm conclusions about the benefits of social prescribing for health and wellbeing
because the evidence from different studies is mixed or conflicting and generally of poor
quality (Mason et al 2019, Bickerdike et al 2017, Polley et al 2017a). A recent realist review50
of social prescribing as a referral pathway from primary care to non-medical community-
based activities also found the evidence base overall insufficient to make general inferences
about the effectiveness of any particular model of social prescribing referral or supported
uptake (Husk et al 2019). Hence the evidence for social prescribing as means of enabling
49 Studies showing positive results are more likely to be published that those that do not.50 Realist review is a method for synthesising evidence from studies of complex social interventions in order to discern what works for whom, in what circumstances.
35
Draft v0.1
primary care professionals to refer patients to local non-medical sources of support leading
to positive health and wellbeing outcomes is widely considered to still be emerging
(Drinkwater et al 2019, King’s Fund 2017).
The realist review was able to discern that:
Patients are more likely to agree to a social prescribing referral if they believe it will be of
benefit and it is presented in a way that matches their needs and expectations
Patients are more likely to attend an activity if it is accessible and transit to the first
session is supported
Activity leaders’ knowledge and skills, and changes in the patient’s condition or
symptoms can influence adherence to activity programmes.
In a qualitative study patients living with long-term conditions in a socioeconomically
deprived area of North East England felt a greater sense of control and self-confidence
following referral by their GP practice to a link worker within the Ways to Wellness social
prescribing service (section 3.1.4) (Moffatt et al 2017). This study also found evidence of
positive effects on health and wellbeing as a result of changes in health-related behaviours,
improvement in long-term condition management, increased resilience and reduced social
isolation. A follow-up study found these patients continuing to make improvements across
various aspects of their lives up to two years after their initial engagement with the service
although many had also experienced setbacks requiring continued support to overcome
problems due to multi-morbidity, family circumstances and socioeconomic factors (Wildman
et al 2019). The findings elucidated the importance of a strong and supportive relationship
with an easily accessible link worker in promoting sustained behaviour change; and that
service users who have complex health and social needs may require link worker support
over the longer term.
Evidence from studies comparing social prescribing via a link worker with usual practice is
scarce. An evaluation of the National Links Worker Programme pilot in Glasgow Deep End51
general practices, which is among the most robust in terms of its methodology, found no
difference in patient outcomes or self-reported healthcare utilisation at nine months
comparing referral to a link worker with usual care in comparison practices that did not
deliver the programme (Mercer et al 2017). It found no difference in health-related quality of
life between patients who engaged with a link worker (rather than just being referred) and
the comparison group, although patients who saw a link worker at least twice showed more
improvement in anxiety symptoms, depressive symptoms, and self-reported exercise levels.
51 This was a collaboration of general practices serving the 100 most deprived populations in Scotland.
36
Draft v0.1
A key limitation of the evaluation design however was its inability to balance patient
characteristics at baseline in the groups being compared because the intervention practices
had the freedom to decide which of their patients should be referred to the link worker. As a
result, estimates of the effects (or lack of effects) on patient outcomes could not be
ascertained with confidence.
Welfare rights advisors as link workers
A report that summarised the evidence base for co-locating socio-legal welfare rights
advisors in healthcare settings in the UK found some evidence of positive health outcomes
for clients, such as reduced stress and anxiety, but a lack of high quality studies able to
demonstrate reliable quantitative estimates of effect (UCL Laws 2017). The report identified
several gaps in the evidence base, noting that longer term benefits may take several years
to emerge and accumulate over multiple support episodes over time; and a need to develop
empirical evidence to understand what works, for whom and in what circumstances in order
to inform expansion of the model. Among the key messages from a workshop for which this
review was undertaken was taking care to avoid over-promising on impact, acknowledging
that people’s lives remain hard even after housing or debt issues are resolved and providing
support at one stage in their life acts as no guarantee for the lifetime resolution of problems.
Children and young people
A recent review of the evidence base for the social prescribing link worker model to improve
the mental health and wellbeing of children and young people failed to identify any relevant
studies despite a thorough search of the published and grey literature (Hayes et al 2020).
The lack of evidence could be due to the fact that social prescribing for children and young
people is still in its infancy compared with social prescribing for adults; or the complexities of
adapting social prescribing approaches designed for adults to the needs of children and
young people, particularly around parent or guardian involvement and consent.
A national audit of children and young people’s mental health and wellbeing services in
Scotland highlighted a reluctance on the part of some GPs and CAMHS professionals to
signpost (sic) young people to voluntary sector services, which the report suggested may be
due to a lack of awareness of what is available, and can leave children and young people
without support and unclear about what options might be available to them (Audit Scotland
2018).52
Volunteers
52 Children and Young People’s Mental Health. Audit Scotland 2018 https://www.audit-scotland.gov.uk/uploads/docs/report/2018/nr_180913_mental_health.pdf
37
Draft v0.1
Volunteering is often one of the opportunities on offer through social prescribing schemes
and it is not uncommon for social prescribing service users to get involved in volunteering
once their own needs had been addressed. Volunteers can also be involved in the delivery
of social prescribing services either as link workers or, more usually, providers of additional
support to service users. There is evidence from various studies linking volunteering with
health and wellbeing benefits such as reductions in anxiety and symptoms of depression,
and demonstrating, for example, greater life satisfaction, more happiness and better physical
and mental health among volunteers compared with non-volunteers (Volunteer Scotland
2015).
Volunteers recruited as social prescribing link workers (Community Navigators) within GP
surgeries in Brighton and Hove reported benefits to themselves including personal
satisfaction, gaining confidence, knowledge, skills and experience, and feeling more
connected to their community and people within it (Farenden et al 2015). Some also gained
employment in the health sector as a result of their link worker experience hence the role
was considered to be an effective volunteer opportunity to support people into employment
and encourage new people into the health sector workforce. Volunteers recruited to provide
extra support and motivation to individuals using social prescribing services that considered
it essential to have paid advisors in the link worker role have also reported that volunteering
in this supporting role provided them with an important stepping stone back into work
(Dayson & Bennet 2016).
Work-related outcomes
On reviewing the published and grey literature the Work Foundation found little reference to
social prescribing as a means to achieve work-related outcomes (Steadman et al 2017). Using
case studies of four link worker social prescribing services in England, including Ways to
Wellness (section 3.1.4), the Foundation identified that work-related outcomes were seen as
valuable but the social prescribing services had no clear pathways to work-related supports.
All four services collected some form of outcomes data, most commonly health service
usage and client health and wellbeing outcomes, but none collected data on work outcomes.
The Foundation concluded that employment needs to become a more considered part of
social prescribing; that link workers may need guidance and training on the role that good
work can have in achieving broader recovery outcomes and should, therefore, be
encouraged to explore the availability of employment supports in the local community.
A recent evidence review on supporting disadvantaged young people to achieve
employment outcomes found the evidence base was not strong enough to draw robust
conclusions on what works; but noted a broad consensus in the literature that effective
38
Draft v0.1
support for young people furthest from the labour market is underpinned by intensive
advisory support and personalised information, advice and guidance: pointing in particular to
the provision of one-to-one advisory support, and continuity of adviser throughout an
intervention period (Newton et al 2020). This review also found a strong consensus that
integrated, comprehensive and holistic approaches to tackle unemployment locally are better
than just focusing on skill acquisition.
3.2.3 Benefits for communities
There is a tendency in the literature on social prescribing to conflate benefits for
communities and benefits for the community and voluntary sector or community groups.
There is also a tendency to infer benefits for whole communities from improvements in
personal outcomes for individuals: the What Works Centre for Wellbeing points out that
community wellbeing is more than the sum of people’s individual wellbeing and is complex to
define.53
Social prescribing has been credited with helping to build social capital by increasing
community involvement through connecting people locally to community organisations and
each other as well as providing opportunities for people supported through social prescribing
to becoming volunteers themselves (Paterson 2019, Polley et al 2017b). Among NHS
England’s criteria for what good social prescribing looks like for communities is that they are
stronger and more tolerant, because people from all backgrounds are supported to be
involved in community groups, and there are more people who volunteer and give their time
back to others (NHS England 2019). There is some evidence for the potential of social
prescribing to engage with diverse and harder-to-reach groups but the evidence on benefits
at community level from its potential to strengthen social capital is not well-developed
(Paterson 2019, Skivington & Smith 2018).
Increasing social capital and ‘impact of programme ethos on community’ were medium to
long-term outcomes for the Glasgow ‘Deep End’ general practices Links Worker Programme
pilot but evidence from early evaluation cast doubt on whether these outcomes would be
fully realised in practice (Smith & Skivington 2016).
Social Return on Investment
Social Return on Investment (SROI) is about social value rather than money (in seeking to
improve wellbeing and reduce inequality and environmental degradation SROI uses
53 What works for community wellbeing: a public debate (2019) https://whatworkswellbeing.org/wp-content/uploads/2020/01/www_comm-deabte-A4-4.pdf
39
Draft v0.1
monetary values to represent a range of social, economic and environmental outcomes as a
widely accessible way to convey value).54
An evidence review of social prescribing services in the UK involving patient referral from
primary care professionals to a link worker reported identifying four studies that estimated
SROI but only reported one study’s estimate—that for every pound of investment in the
Weston-super-Mare Healthy Connections service project, £2.73 of social value was created
(Polley et al 2017a). The review referenced only one of the other three studies, which
showed that for every pound of investment in Bristol’s Wellspring Healthy Living Centre's
Social Prescribing Wellbeing Programme, £2.90 of social value was created. The studies
reviewed were reportedly difficult to compare because they used inconsistent combinations
of potential benefits.
A study in Scotland that forecast the SROI for co-locating welfare advice workers in medical
practices based on three medical practices in Edinburgh and Dundee predicted that every £1
invested over a one-year period (2015 to 2016) would generate around £39 (range £27 to
£50) of social value (Carrick et al 2016).
Reducing health inequalities
Evidence on reducing health inequalities within communities suggests that interventions that
improve accessibility to appropriate services, prioritise disadvantaged groups and provide
intensive individualised support are more likely to be effective (Health Scotland 2016, Lorenc
et al 2013, Macintyre 2007). Conversely, services that only provide information, rely on
people taking the initiative to opt-in, or present cost or other barriers to accessibility are less
likely to reduce health inequalities. Consequently, it is believed that social prescribing
models based solely around signposting or unsupported referral to other services are
unlikely to reduce health inequalities and may even result in widening inequalities because
those who are more socially disadvantaged are less likely to take up the opportunities on
offer without additional support.
3.2.4 Benefits for delivery partners
Social prescribing as a means of connecting people to community-based supports to help
improve their health and wellbeing lends itself to cross-sectoral partnership working between
statutory health and social care providers and the community and voluntary sector as
providers of services and activities in the community.
Statutory sector
54 The SROI Network 2012 http://www.socialvalueuk.org/app/uploads/2016/03/The%20Guide%20to%20Social%20Return%20on%20Investment%202015.pdf
40
Draft v0.1
The evidence base for the benefits of social prescribing for statutory care providers focusses
on outcomes relating to primary and secondary healthcare services.
A widely-cited review of UK studies that assessed the impact on healthcare demand
associated with social prescribing services involving patient referral to a link worker in
primary care found evidence an average reduction in patient demand for GP services of 28%
(range 2% to 70% across 7 studies). The Royal College of General Practitioners (RCGP)
believe the findings from this review could suggest promising outcomes for GP workload
through social prescribing, which NHS England has identified as one of 10 high impact
actions with the potential to increase capacity and reduce workload in general practice
(RCGP 2018). A RCGP survey55 of GP perceptions on the anticipated impact of these
actions on their workload found that 59% of the 143 GPs in England who responded thought
that social prescribing would decrease their workload while 13% felt it would increase it
(RCGP 2018).
The same review also found evidence of an average fall in Accident and Emergency (A&E)
attendance of 24% (range 8% to 26.8% across 5 five studies); and a fall in emergency
hospital admissions of between 6% and 33.6% (across 3 studies) in the months following a
social prescribing referral (Polley et al 2017a). One study reported a significant reduction in
secondary care referrals whereas another study showed referrals to secondary mental
health care more than doubled for patients with psychosocial problems.
The review concluded that although the evidence for social prescribing was broadly
supportive of the potential to reduce demand on primary and secondary care the quality of
the evidence was weak and it would be premature to conclude that a proof of concept for
demand reduction had been established (Polley et al 2017a). The RCGP report states there
is limited robust evidence around social prescribing and the GPs surveyed often expressed
higher scepticism about actions where strong evidence is lacking, emphasising the
importance of communicating evidence of impact and sharing case studies (RCGP 2018).
A recent Public Health England review that assessed UK studies involving referral to a social
prescribing link worker in primary care and looked at contact with primary healthcare
services as an outcome (such as the frequency of GP consultations) similarly found
inconsistent results across seven studies of generally low quality, and concluded there was
no clear evidence of effectiveness (Mason et al 2019).
Evidence mapping by the Public Health Wales Observatory also failed to identify sufficient
evidence from published research or experience of implementing social prescribing
initiatives, in terms of quality and the outcomes reported, to answer the question of whether
55 RCGP survey conducted December 2017 to January 2018
41
Draft v0.1
social prescribing reduces demand for mainstream primary and community care (Price et al
2017).
Social prescribing initiatives in secondary care settings are not as common as in primary
care. An recent project that aimed to contribute to knowledge about the best way to utilise
social prescribing in secondary care ran a six-month pilot of a voluntary sector led social
prescribing service in one London Hospital in an area that already had a well-embedded
social prescribing service in primary care (Family Action 2018). The service offered up to
eight sessions with a link worker who provided practical and emotional support with non-
clinical needs such as finances, housing, and carers support and facilitated referrals to
appropriate community organisations. The service model aimed to achieve healthcare
system outcomes including reduced discharge delays, reduced readmissions, reduced
demand on hospital staff, and improved integration with primary care but this could not be
assessed within the short timescale. Fewer referrals to the service than anticipated was
thought to be due to it not being available on the hospital management system for secondary
care staff to refer easily, and the length of time required to embed a service within secondary
care pathways.
Community and voluntary sector
Community and voluntary sector organisations have a vital role to play in any social
prescribing initiative as the main providers of community-based services and supports; and
in some delivery models also providing a link worker function. A range of potential benefits to
the sector from involvement in social prescribing have been suggested, such as
strengthening relationships with statutory services, reaching more and new clients, building
community assets, securing sustainable funding, and increased resilience (Davison et al
2019, CordisBright 2019). Evidence on the extent to which these benefits are realised is
limited as most studies and evaluations of social prescribing initiatives do not appear to
assess them.
The views of community organisations receiving referrals through the Glasgow Deep End
general practices Links Worker Programme pilot provided some evidence of benefits from
working collaboratively (Smith & Skivington 2016, Skivington & Smith 2018). Evaluation
showed evidence of progress towards increasing and strengthening cross-sectoral
relationships, albeit largely between the link workers and individuals within community
organisations rather than between GP practices and community organisations as a whole.
Community organisations saw the link workers as being able to facilitate a community
organisation presence within GP practices, and their potential to educate practice staff about
the community resources available locally. There was also evidence of improvement in the
42
Draft v0.1
appropriateness of referrals, in that community organisations felt that the patients referred
through the link workers were more appropriate for their service than the referrals they had
received from GP practices before the link worker model was implemented. Hypothetically,
some community organisations considered that they might be in a better position to apply for
funding because of increased referrals from the Links Worker Programme.
Evidence of impact on the scope and capacities of community resources to support people
to live well, which was a medium-term outcome for the Deep End Links Worker Programme,
was limited—for example, a few community organisations being supported by link workers to
develop their capacity through funding applications and shared events.
3.2.5 Cost and cost effectiveness
A systematic review of social prescribing initiatives in the UK involving referral to a link
worker in primary care found insufficient evidence to reliably judge value for money
(Bickerdike et al 2017). A review that identified eight UK studies involving referral to a link
worker in primary care that reported some kind of cost analysis (having found no studies of
cost effectiveness or cost utility) concluded that the evidence that social prescribing delivers
cost savings to the health service over and above operating costs was encouraging but by
no means proven or fully quantified (Polley et al 2017a). A previous review by the King’s
Fund concluded there was a need for more evidence about the cost-effectiveness of roles
like link workers; and questions remained around the scale at which such roles need to be
developed to release cost savings elsewhere in the system (Gilburt 2016). The evaluation
that compared Glasgow Deep End general practices implementing the National Links
Worker Programme with practices that did not deliver the programme concluded that
evaluation of longer term outcomes over 23 years, with linked health and social care
utilisation data drawn from robust sources, would be required to assess whether or not the
programme was cost effective (Mercer et al 2017).
The assessment of the evidence base for co-locating socio-legal welfare advisors in
healthcare settings in the UK noted that although service evaluations consistently report
direct financial gains to advice recipients that outweighed the costs of providing the service,
there was an evidence gap around robust economic analysis of cost-benefits and
efficiencies for health services (UCL Law 2017).
3.2.6 Effective principles
The Social Prescribing Network emphasises that successful social prescribing schemes are
locally designed to suit the people they are aimed at, which means embedding core
principles into the design rather than using one standardised model.56 A recent review 56 https://www.socialprescribingnetwork.com/
43
Draft v0.1
concluded that the evidence regarding the elements of practice that make for effective social
prescribing is limited to evaluations of local initiatives and evidence from experience
(CordisBright 2019).
In 2016, Health Scotland identified key facilitative factors for effective social prescribing for
mental health (Health Scotland 2016), including:
Engaging the individual in identifying the support required, based on their needs
Engaging local partners and stakeholders in the design of local approaches, maximising
the contribution that each can make, including statutory and community and voluntary
sector agencies and communities
Building relationships and trust within the local partnership to support planning, delivery
and evaluation
Embedding the approach within wider pathways and routes of referral
Supporting capacity building within all sectors, so that staff and volunteers feel able to
support social prescribing
Equality proofing local approaches to ensure they do not widen health inequalities
Monitoring and evaluating local approaches in order to build the evidence base for what
works.
As noted in section 3.1.4, the link worker role has come to be widely considered as essential
to the successful delivery of social prescribing in healthcare settings.
A contemporary guide commissioned by NHS England, coproduced by people with practical
experiences of designing, commissioning, delivering, and evaluating social prescribing
schemes in the UK, describes essential ingredients that successful schemes have in
common (Polley et al 2017b). NHS England also engaged a wide range of stakeholders to
identify key elements of what makes a good social prescribing scheme and what needs to be
in place locally (NHS England 2019). These together provide a good representation of key
factors identified by others, and include:
Collaborative commissioning and partnership working: all partners work together in local
areas to build on existing community assets, co-producing and co-commissioning local
social prescribing schemes; the community and voluntary sector is involved from the
start; local organisations with deep-rooted community networks need to be
commissioned to provide social prescribing services
Funding commitment to ensure funding to support and maintain the link worker position;
it is important that money follows the patient, and that the community-based
44
Draft v0.1
organisations receiving referrals can plan ahead and sustain their income and service
provision
Buy-in from referring healthcare professionals: educating healthcare professionals, and
other referrers, on aspects of social prescribing is very important
Easy referral from a wide range of local agencies in order to coordinate support around
the person and encourage partnership working; referral criteria need to be designed to fit
the target people for the social prescribing scheme, and need working out with all
partners to ensure transparency
Statutory bodies should work with partners to create reasonable and safe referrals,
based on what matters to people, whilst minimising bureaucratic controls and working to
overcome an overly risk-averse approach to local community development
Informed decision-making before referral to social prescribing is important to ensure
people can exercise choice, they know what to expect, and that it is right for them
Communication between sectors: commissioners need to be clear about intended
outcomes for the service they are commissioning (in terms of who the service is
targeting); and it is important for the referrer to know if the person referred receives the
support they need
A service delivery steering group involving all stakeholders is also considered important and
the earlier they come together and work in partnership the better chance of success for the
social prescribing scheme.
The developers of the Ways to Wellness ‘hub’ delivery model (section 3.1.4) that enables
GP practices to refer patients to link workers situated within community organisations added
‘a visible base in each locality’ as a key principle, to increase healthcare practitioners’
awareness of community and voluntary sector provider organisations. This model is similar
in this way to the SPRING Social Prescribing Project (section 4.3.3) currently being delivered
in North Lanarkshire whose developers recognised that situating link workers within well-
established local community-led health organisations, to ensure they are well-linked-in to
community provision and well supported, as critical to its success.
Learning from community and voluntary sector experience echoes many of the
aforementioned principles and offers further insight on effective practice from the perspective
of vital delivery partners for social prescribing.
In 2015, Volunteer Scotland, in partnership with Scottish Government’s Health Directorate,
explored third sector perspectives on barriers and enablers to introducing social prescribing
45
Draft v0.1
in a primary care setting (Volunteer Scotland 2015). Learning from that exercise included the
following points on effective practice:
Social prescribing works best where all those involved have a good understanding of
what it is, what it can offer and who it can benefit
Unlocking the full potential of social prescribing will only work if productive partnerships
and alliances are formed and key sector partners are connected
Social prescribing is not a quick fix or a bolt-on and it takes time to introduce an effective
and sustainable model
To really work in partnership may require giving away some power to other players
Good partnership working is crucial if healthcare practitioners are to know what
community-based services are able to provide and deliver
To be effective, social prescribing very much depends on primary care staff having a
good knowledge of what services are available in the community: the asset mapping of
local groups and services into electronic directories can help to establish uniform access.
Good communication and guidance is needed from all sector partners as to what
patients can expect from social prescribing and how they can benefit from it: it’s
important that patients see the support that they receive as part of their care package
and not separate
A recent report from the National Lottery Community Fund offers learning from funded
projects piloting or scaling social prescribing, or providing services as part of existing
schemes, to help others thinking of designing, improving or expanding social prescribing
initiatives (Davison et al 2019). This largely relates to link worker models, with the link worker
role seen to have an essential position at the heart of social prescribing (acknowledging that
community and voluntary sector organisations often provide the link worker function).
Learning from this work echoes that of others in that:
All stakeholders including commissioners, referrers and delivery partners need to have a
common understanding of key terms and principles
Social prescribing schemes need to be joined up and key partners need to be on board
from the start
Understanding the local context is important in preventing barriers to an effective and
joined up social prescribing service
Partners should cooperate at strategic and operational levels and recognise, from the
planning stage through to final delivery, what each has to offer the others
46
Draft v0.1
Standards and quality assurance for community-based services can improve confidence
in social prescribing
Making a referral should be as simple as possible
Referrals to community-based services must be appropriate and at a level that is
sustainable
Both the link worker role and the delivery of community-based services must be
adequately funded for social prescribing to flourish
Social prescribing works best when organisations are willing to work with each other
towards shared goals and to share learning, and when funding does not create perverse
incentives and competition
Showing how social prescribing contributes to preventing ill health and improving health
and wellbeing is essential to gaining credibility, buy-in and sustainable funding.
A scoping exercise involving surveys of third sector providers and third sector interfaces
undertaken by Voluntary Health Scotland to help inform the development of the national GP
Community Link Worker programme (Voluntary Health Scotland 2017), suggested from its
findings that the most effective way of using the third sector would be to:
Actively involve the sector in the design and planning of services, recognising and
drawing on its areas of expertise.
Provide a greater range of mainstream service delivery opportunities through contracts
and Service Level Agreements.
Further develop its contribution to specialist service delivery, wherever it has a
recognised specialism.
Its recommendations included that:
Cross-sectoral approaches to workforce development and planning should be
significantly strengthened to maximise the sharing of knowledge skills and experience
The major contribution of volunteers should be further developed, recognising that they
are not a ‘cost free’ resource
The focus of investment should be on models that build and sustain community capacity
Community Link Worker programmes should aim to commission third sector
organisations for a minimum period of three years to ensure quality, partnership and
workforce development, and meaningful evaluation
47
Draft v0.1
A report that describes social enterprises’ views on what would improve social prescribing
activity in Scotland and how its impact could be maximised (senSCOT 2018) identified four
overarching principles:
Strong partnership working
Value community and existing resources
Widen understanding of need
Realistic resourcing of social prescribing
Strong partnership working reiterated the need for a shared understanding of social
prescribing to harness collective action; and recognising the contribution that all partners
bring, including the local community, and the barriers they face. Valuing communities and
existing resources included making connections between existing services and activities;
and investing in community capacity building. Widening understanding of need included
identifying and addressing gaps in service design and planning; and openness to
considering all types of activities. Realistic resourcing reiterated investing resources to
ensure capacity exists to meet the higher levels of demand for community-based supports
that more social prescribing may bring; and embedding sustainability by ensuring that
funding follows the individual. It also brought out the need to improve recording of outcomes
to create evidence of the difference it makes, adding that this is needed to tackle potential
bad press on alternative spending of NHS money.
48
Draft v0.1
Section 4. North Lanarkshire’s foundations for social prescribing
4.1 Community and voluntary sector
4.1.1 Support infrastructure – Voluntary Action North Lanarkshire
North Lanarkshire has a capable community and voluntary sector infrastructure organisation
in Voluntary Action North Lanarkshire (VANL). As the third sector interface for the North
Lanarkshire local authority area, VANL receives core funding from the Scottish Government
and North Lanarkshire Council to support community and voluntary sector leadership and
collaboration, individual organisations and volunteering. VANL provides a single point of
access for advice and support for the community and voluntary sector and has a strategic
role in enabling the sector’s involvement in community planning and integration, responding
to local needs and delivering outcomes. VANL’s Chief Executive Officer is a non-voting
advisory member of North Lanarkshire’s Integration Joint Board (IJB), which has
responsibility for planning, commissioning and overseeing the delivery of community health
and social care services across North Lanarkshire’s six localities.57
4.1.2 Range of services and activities
North Lanarkshire’s community and voluntary sector encompasses over 1800 diverse
groups and organisations contributing to the wellbeing of people and communities, including:
Local community groups, many run entirely by volunteers and often not registered as a
charity
Small, medium and larger charities, some of which are local branches of national
charities, usually employing staff and assisted by volunteers
Social enterprises including housing associations and co-operatives.
North Lanarkshire has 450 voluntary sector charities registered on the Office of the Scottish
Charity Regular (OSCR) Scottish Charity Register, which in terms of the number per 1000
population (1.3) is fewer than in any other local authority area (2018).58 Just over half (55%)
of these charities are small organisations (annual income less than £25K) yet they account
for only 0.7% of the overall annual income (2017/2018) whereas the largest organisations
(annual income greater than £1M) that make up only 5% of the sector in this sample account
for 87% of its annual income.
57 https://www.hscnorthlan.scot/ 58 SCVO State of the Sector 2020
49
Draft v0.1
Almost half (48%) of the registered charities are social care organisations, with culture and
sport next accounting for 13%, followed by organisations categorised as providing
community, economic and social development activities (10%) and health (5%) with various
other activities making up the remainder.
Many community and voluntary sector organisations rely on volunteers in order to deliver
supports. Less than a third (30%) of charities on the Scottish Charity Register employ paid
staff and 4 out of 5 (83%) paid staff are employed by the largest 5% with annual turnovers of
over £1M. Over half of all paid staff in this sample are employed by social care and health
organisations (ibid footnote 59).
There is a strong volunteering culture in North Lanarkshire where an estimated 27% of
adults (around 75,000 people) volunteer formally through an organisation or community
group, similar to the national average of 28%.59 Participation in the Saltire Awards also
indicates a positive youth (aged 11–25 years) volunteering culture in North Lanarkshire.60 In
2016, volunteers living in North Lanarkshire provided an estimated 7 million hours of help to
others and contributed around £102M to the local economy (ibid footnote 60). Data from
2014 indicated that over a quarter (27%) of people who volunteer have a disability or long-
term condition.61
4.1.3 Locator
Locator is North Lanarkshire’s online repository and search tool that anyone can use to find
information about community-based supports in the area. Locator is maintained by VANL
and lists details provided by local voluntary organisations including community groups,
activity groups, peer support groups and advisory organisations (at present there are no
listings for social enterprises).
59 Scottish Household Survey 2017 https://www.volunteerscotland.net/for-organisations/research-and-xxxxxx`evaluation/data-and-graphs/local-area-profiles/north-lanarkshire/60 North Lanarkshire Community and Voluntary Sector Children, Young People and Families Strategy 2020–2023 (Draft 5)61 North Lanarkshire Equality Strategy 2019–2024 https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=23430&p=0
50
Draft v0.1
Locator currently lists 528 entries offering a wide range of activities and supports under the
following categories:
Activity for Carers
Activity Group
Advocacy
Arts and Crafts
Befriending
Bereavement Support
Bookbug
Cafe
Call Line
Cancer Support
Carer Support
Coffee\Drop In
Community Council
Community Transport
Complementary Therapies
Credit Union
Dance
Dementia Support
Faith
Fitness
Friendship Group
Green Health
Handy Person Service
Healthy Living
Healthy Start Vitamins
Home Care
Hospice
Housing\Residents Association
Information and Advice
Learning Opportunities
Lunch
Mental Health Support
Meals on Wheels
Music
Palliative Care
Parent and Toddler
Shop Mobility
Singing
Social Group
Stroke Club
Support Group
Thematic Frameworks
Visual Impairment Support
Individuals and organisations can search Locator by type of
support or activity or using key words and limit their search
by postcode and radius. Locator also has a map function to
show the geographical availability of the listed types of
services and activities across North Lanarkshire. VANL can
provide training on how to use Locator if needed.
In the period from 1st April 2019 to 5th March 2020 almost
8,500 users spent over 11,000 sessions accessing
information across over 41,000 page-views on Locator
(Douglas Milne, Organisational Development Advisor, VANL,
Personal Communication 6th March 2020).
Locator’s content relies on organisations providing VANL with details about their services
and activities and informing VANL of any changes so information can be kept up to date.
This can be challenging for community and voluntary organisations operating under capacity
constraints, and particularly smaller community groups who more often depend on short-
term activity-based funding.
Locator has undergone improvements since it was constructed in 2014 and is currently
undergoing further development funded through the Community Solutions Programme
(section 4.2.1) under its enabling services function.
Locator is listed on North Lanarkshire Council’s Making Life Easier resource (section 4.3.2).
51
Draft v0.1
4.2 Partnership working with Health and Social Care North Lanarkshire
4.2.1 Community Solutions Programme
Health and Social Care North Lanarkshire (HSCNL) recognises that an assets-based
approach to community capacity building and co-production at locality level can result in
better outcomes for people, especially at the prevention and anticipatory care end of the
care pathway, and that the community and voluntary sector is best placed to implement it.
Community Solutions62 is a strategic investment programme described as the third sector
branch of HSCNL. As a partnership initiative, Community Solutions was developed jointly
with HSCNL for the community and voluntary sector to take a co-ordinated approach in its
strategic contribution to ensuring every person in North Lanarkshire receives the right
support in the right place at the right time. The Programme has been in place since 2013.
Community Solutions currently receives annual core funding from HSCNL’s integrated
budget allocated through the IJB, which together with additional funding from other sources
is managed through VANL as the Programme host. In the year 2018–2019, the Programme
used its £1.14M core funding to leverage £485,000 in additional funding and gain in-kind
contributions of approximately £63,000.63
The Community Solutions Programme model embodies co-production
within its four pillars of Locality Development; Community Support;
Carer Support; and Enabling Services. Local consortia involving
community and voluntary sector organisations, service users and
statutory partners are hosted by a voluntary organisation in each of
North Lanarkshire’s six localities. The Consortia work to understand the
needs within their local community and, in partnership with community representatives and
other partners, co-commission local services to meet those needs. They also ensure that the
whole of the community and voluntary sector in North Lanarkshire is represented on all
Locality Planning Groups.
Community Solutions project funding is allocated in line with the Programme’s 5-year
strategy64 and commissioning plan and is governed through a ‘triple lock’ structure involving
the North Lanarkshire Wide Consortium in local solutions co-design at level 1; scrutiny and
review by a Governance Subgroup of the IJB at level 2; and approval from the HSCNL
Senior Leadership Team at level 3. The level of funding ranges from investments of up to
62 Previously called the Community Capacity Building and Carer Support (CCB&CS) Programme 63 Community Solutions End of Year Report 2018/201964 North Lanarkshire Community Capacity Building and Carer Support Strategy 2018/23
52
Draft v0.1
£75,000 in initiatives categorised under nine thematic strategic priorities to micro-funding
distributed via the locality Consortia from an annual Locality Activity Fund of £30,000 per
locality. In 2018—2019, in addition to the funding of thematic priorities more than 60
community-based groups and organisations across North Lanarkshire received funding
through the Locality Activity Fund.
The Community Solutions Programme focusses on personal outcomes achievement for
service users based on its overarching strategic priorities—addressing inequalities and
reducing loneliness and isolation—and implements a common monitoring and evaluation
framework. Projects report against agreed programme outcomes for adults, children and
young people, and carers. The Programme Manager provides the Senior Leadership Team
with regular performance updates and reports annually to the IJB.
In October 2019, VANL embarked on the development of an improved Monitoring,
Evaluation and Learning Framework for the Community Solutions Programme in order
to strengthen the collection and use of data to measure progress, demonstrate impact,
inform decision making and enhance learning for improvement in line with HSCNL’s
emerging priorities. A report on this work will be available in June 2020.
Improvement Service review
In March 2019 the Improvement Service supported a review of the Programme in which
stakeholder opinion was sought on key aspects of its approach in relation to outcomes-
focussed partnership working. Stakeholders, including statutory and community and
voluntary sector partners, were sent an electronic checklist of statements and the
Improvement Service analysed the data collected on respondents’ agreement with those
statements. The review identified three areas of strength, based on statements with the
highest agreement scores, as follows:
Strategic planning—based on agreement with the statement that the Programme’s
strategy demonstrates an understanding of local needs and opportunities.
Focus on outcomes—based on agreement with the statement that the Programme’s
outcomes link to the nine national outcomes.
Reporting impact—based on agreement with the statement that by working together, the
Programme has delivered improvements which would not have been delivered by
individual organisations.
Free text comments highlighted strong stakeholder confidence in the Programme’s structure
and governance procedures.
Four areas for improvement were identified and actions agreed, as follows:
53
Draft v0.1
Improve the use of localised data in identifying key challenges and needs for localities—
actions included working with HSCNL on ways to use third sector data to build a more a
holistic picture of community needs.
Consider how the process of funding can be improved to support more effective strategic
planning—actions included reviewing the governance process, looking at longer term
funding and working to realign more strategic third sector investment through the
Community Solutions Programme.
Identify more innovative and accessible ways to share information including performance
governance, key messages and Programme branding—actions included a rebranding
exercise from which the then CCB&CS Programme was re-named Community Solutions.
Explore how the Programme can better market and celebrate its achievements across
North Lanarkshire—actions included developing a communications strategy and
investing in a dedicated communications officer.
4.2.2 Partnership for Change
Partnership for Change is a service user and carer led organisation founded by four
voluntary sector organisations (Voice of Experience Forum; Lanarkshire Links; North
Lanarkshire Disability Forum; North Lanarkshire Carers Together) to provide a platform for
service users and carers to engage with the changes taking place across health and social
care services. Partnership for Change works to ensure meaningful service user and carer
engagement and participation in shaping joint priorities for community care within the
integration of health and social care agenda across North Lanarkshire.65 Partnership for
Change holds quarterly assimilation meetings for service users, carers and providers from all
sectors where information is shared and engagement sought on current integration initiatives
that affect health and social care provision in North Lanarkshire. A partnership working
agreement between Partnership for Change and Community Solutions ensures best use of
shared resources, efficient communication around developments in health and social care
integration, and maximum service user and carer engagement at all levels. The Partnership
for Change lead sits on the Community Solutions Programme Governance Subgroup and
consortia members attend assimilation meetings.
65 https://www.alliance-scotland.org.uk/blog/our_members/partnership-for-change/
54
Draft v0.1
4.3 Social prescribing initiatives
4.3.1 Well Connected
Well Connected is described as Lanarkshire’s social prescribing programme for mental
health and wellbeing.66 The programme was launched in 2012 and involves a range of
partners including NHS Lanarkshire, North Lanarkshire and South Lanarkshire councils and
the third sector. Well Connected is designed to help people who may be experiencing
symptoms of stress or low mood, and anyone who wants to feel better in themselves and in
their life, connect with a range of non-medical support services and activities in their local
communities that can benefit their wellbeing. The programme currently provides information
in a booklet format (one for North Lanarkshire67 and one for South Lanarkshire) that
individuals and those who support them can use to help access the eight types of
opportunities that it offers:
The initial drivers for Well Connected were the desire to support people who were presenting
at primary care with low level mental health problems and being prescribed antidepressants,
and the need to be using existing community assets more effectively68 The programme’s
assets-based approach in recognising and harnessing existing knowledge, skills and
expertise within services already in place across Lanarkshire has enabled implementation at
minimal additional cost.69 Learning from a pilot project helped inform development of the
programme’s support pathways and the services listed were originally selected to align with
the Five Ways to Wellbeing (Connect; Be Active; Keep Learning; Help others; Take notice).
A number of additional sources of information that lie outside the eight core areas, or
domains, have been added to the Well Connected listings over the years such as NHS
Lanarkshire’s stop smoking services, North Lanarkshire Council’s Making Life Easier
66 http://www.elament.org.uk/self-help-resources/well-connected-programme.aspx67 http://www.elament.org.uk/media/1904/wellc-nth-bklt-jul2018-screen2.pdf 68 Elspeth Russell, Assistant Health Promotion Manager, NHS Lanarkshire, July 2017 in The Social Prescribing Project [SPRING] Business Plan Appendices 2017.69 http://www.healthscotland.scot/media/2077/well-connected-lanarkshire-case-study.pdf
55
Physical Activity and Leisure
Stress Control Classes Arts and Culture
Healthy Reading and Self-Help Information
Benefits, Welfare and Debt Advice Learning VolunteeringEmployment
Draft v0.1
(section 4.3.2) and the Scottish Association for Mental Health (SAMH) Well-informed
Information Service in North Lanarkshire.
Through Well Connected, people can find information for themselves or be signposted by a
care provider to the relevant listed services; and in promoting the SAMH Well-informed
Information Service it offers a route to information about other resources that are available
locally and access to a Community Link Worker for people who may need more intensive
support to engage with local services and participate in activities.
The collection and use of data for evaluation is currently being looked at with support from
the Department of Public Health for NHS Lanarkshire.70 Gathering data on numbers of
people accessing the listed services through Well Connected has not been possible to date
with a few exceptions such as North Lanarkshire leisure services that can report on numbers
of referrals received through Well Connected. A Well Connected app is currently being
developed to enhance user accessibility that will also improve the programme’s ability to use
data analytics to evaluate the programme’s effectiveness in promoting access (ibid footnote
71). Data on service user outcomes is also limited, again with some exceptions such as for
stress control classes, which is a service delivered in-house by NHS Lanarkshire that
measures change in participants wellbeing scores.71
4.3.2 Making Life Easier
Making Life Easier is an online service provided by ADL Smartcare for North Lanarkshire
Council.72 It offers information, advice and direct access to services for people living in North
Lanarkshire with long term conditions or a disability or who are experiencing difficulties with
everyday activities as they get older.73 The website provides information on national support
organisations and local self-help groups, and a link to the Locator tool (section 4.1.3) to help
people find other local community-based support groups and activities. In addition to general
advice on various aspects of health and wellbeing, and hints and tips on how to carry out
everyday activities independently, Making Life Easier also offers people the opportunity to
complete a guided self-assessment in order to access personalised professional advice and
direct access to statutory services and supports including equipment. The collection of
personal data is covered by the General Data Protection Regulation (GDPR).
4.3.3 SPRING Social Prescribing Project
The SPRING Social Prescribing Project is the largest coordinated project of its kind, bringing
together 30 community-led health organisations including 10 delivery partners in Scotland of 70 Susan McMorrin, Senior Health Promotion Officer, Personal Communication, 17 March 202071 Flash report obtained from Susan McMorrin72 https://www.makinglifeeasier.org.uk/73 https://www.northlanarkshire.gov.uk/CHttpHandler.ashx?id=4156&p=0
56
Draft v0.1
which three are based in Lanarkshire: Health Valleys (Lanark) and the Healthy and Happy
Community Trust (Rutherglen) in South Lanarkshire; and Getting Better Together (Shotts) in
North Lanarkshire. The project is being delivered in partnership between Scottish
Communities for Health and Wellbeing (SCHW) and the Healthy Living Centre Alliance
(HLCA) in Northern Ireland with funding from the National Lottery Community Fund. The
Fund is providing £3m to fund the ten delivery partners in Scotland with £40,000 per year for
at least three years to develop the project and host Social Prescribers.
The SPRING project defines social prescribing as: a way to link medical care to (typically)
non-clinical, locally delivered support services. The SPRING social prescribing approach is a
link worker model in which local GP practices who agree to participate refer patients to
Social Prescribers based within well-established local community-led health organisations—
the anchor organisations. The Social Prescribers are tasked with engaging GP practices in
their local area, which for Getting Better Together is the Greater Shotts area. The project has
standardised referral criteria (informed by a pilot project in Northern Ireland) targeting people
(aged 18 and over) thought most likely to benefit from a social prescription such as patients
(or carers) experiencing social isolation, loneliness or low level mental health problems, and
other factors including physical inactivity, chronic conditions, inconclusive diagnoses or poor
results with mainstream treatments, and frequent attendance at primary care services.
The Social Prescriber works with each individual referred to co-create their social
prescription and a personal ‘health pathway’ that gives them control over their journey;
connects them with suitable services and opportunities in the community and gives them the
support they need to access services, engage with groups and join-in activities to help them
achieve their health and wellbeing goals. The project draws on a range of local supports and
activities and offers each individual 12 interventions. Funding to cover the costs of
interventions follows the patient (anchor organisation hold the budget for their area and
when people engage in activities run by other organisations the associated budget passes to
that provider) and the project provides each local delivery partner with £5000 pa for local
capacity building to fill identified gaps in local activities and supports.
The project’s overall goal is that at least 8,000 people will co-create a social prescription and
engage in at least one contact intervention in order to deliver a total of 96,000 interventions
overall in the first 3 years: that equates to 2000 interventions for 160 separate individuals per
year for each local delivery partner. By working at this scale SPRING aims to gather enough
robust evidence of the impact of social prescribing to influence policy decisions and change
the way that healthcare budgets are set in order to shift the focus towards preventive spend
on health and wellbeing in the community. The role of the project’s Strategic Advisory Panel,
whose membership includes operational, finance, policy and political representation, is to
57
Draft v0.1
champion the project within governments and the NHS in order to influence long-term
cultural change in the way health generation and improvement is delivered nationally. The
aim over the duration of the project is to secure policy commitments to fund social
prescribing longer term and role the model out across both regions.
SPRING uses the Elemental Core digital platform provided by Elemental Software74 to
facilitate project management and impact assessment (the project’s funding includes
£40,000 per annum for the online system). The system enables Social Prescribers to receive
referrals from GP practices in real time; and clinicians and Social Prescribers to monitor and
track referrals, log progress, build a case file and aggregate reports. Its features include a
social prescription generator for referring individuals to community based interventions, a
calendar that generates bookings with providers that is integrated with the participant’s
personal calendar, an attendance tracker, impact measurement using the Warwick-
Edinburgh Mental Well-being Scale and the Outcomes Star (Wellbeing Star) to track
improvement in health and wellbeing, and a cost-saving analysis tool.
The project incorporates formative evaluation being undertaken by external consultants
(CavanaghKelly) using a theory based approach.75 Information will be collected through
Elemental and other methods including surveys, case studies and qualitative feedback
gathered from focus groups, regional managers meetings and the Strategic Advisory Panel.
The evaluation framework includes measures of impact for people, healthcare, communities
and government.76
There is an optional break clause at the end of year three (2021) in the project’s five-year
plan (2019–2023) to allow the partnership and funders to consider the year three evaluation
report and decide on that basis if and how the project would continue into years four and
five. The year one evaluation is currently in draft form and should be available in June 2020
(John Cassidy, Chair, SCHW, Personal Communication, 11 March 2020).
74 https://elementalsoftware.co/75 The project budget includes £38,000 for evaluation76 Approach to evaluation framework, January 2019, obtained from June Vallance, GBT
58
Draft v0.1
4.3.4 Other link worker roles
In addition to the SPRING project Social Prescribers there are several other link worker roles
and initiatives currently operating in North Lanarkshire performing functions recognisable as
social prescribing, some of which are described here.
SAMH GP Link Workers and Community Link Workers
Six SAMH GP Link Workers are based in GP practices in North Lanarkshire’s six localities.
They offer a person-centred response to patients’ mental health needs by working
collaboratively with individuals to identify their needs and connect them with suitable
community resources. They also work to develop links with the community in order to create
opportunities for patients locally. The support is generally provided over four 30-minute
sessions.
SAMH Community Link Workers offer support in the community for up to six weeks to help
motivate and support individuals who need it to engage with local opportunities and activities
and encourage self-management. They also work to map the availability of local
opportunities and resources. The Community Link Workers receive referrals from various
agencies as well as self-referrals and can refer individuals on to peer support and more
intensive support services provided by SAMH. As individuals are not followed up once
contact with the Link Worker has ended the extent to which community engagement is
sustained or personal objectives achieved is not known (SAMH Community Link Worker,
Personal Communication,13 December 2019).
Support in the Right Direction Community Connectors
The Scottish Government’s Support in the Right Direction (SiRD) programme funds local
projects across 31 local authority areas through its delivery partner Inspiring Scotland to
deliver independent support to individuals, families and carers accessing the social care
system. North Lanarkshire Disability Forum receives SiRD funding governed through the
Community Solutions Programme (section 4.2.1) for the employment of two full-time
Community Connectors who offer a service to people in North Lanarkshire who are not yet
eligible for self-directed support. The Community Connectors offer one-to-one support to
help people decide what their needs are and connect them to appropriate services and
supports in their local community. The Community Connectors also work to promote their
service to potential users and referrers in the North Lanarkshire area and build connections
with local community support providers. The project has funding for three years (2019–2021)
with a budget that includes funding for advocacy support provided through Equals Advocacy.
The programme’s success is being evaluated nationally using a theory based approach and
all funded projects are required to report on how their project outcomes contribute to the
59
Draft v0.1
programme’s high-level outcomes.77 The service was initiated in September 2018 with the
first six months to March 2019 start-up period including recruitment and development of the
Community Connector role. In the six months from April to September 2019 the Community
Connectors supported 56 people, 21 of whom also benefited from advocacy support (SRiD
Activity and Outcomes Report 1April 2019–30 September 2019).
Hospital Discharge Community Liaison Coordinators
Through the Hospital Discharge Support Programme, two Community Liaison Coordinators
based in Monklands and Wishaw General Hospitals provide a link between acute settings
and supports provided by third sector organisations in the community. The Community
Liaison Service is available to all North Lanarkshire residents (aged 16 years and over) in
hospitals and NHS sites and accepts referrals from health and social care professionals as
well as self-referrals from patients, families and carers. The Community Liaison Coordinators
meet with service users to discuss their support needs and offer tailored information,
signposting and referrals to suitable community supports. This can include self-
management, welfare rights, future planning, support for carers, social opportunities, leisure
and physical activities, and how to provide feedback on services received. The service is
funded through the Community Solutions Programme and has been since 2015. It was
introduced as a test of change to support discharge and prevent people returning to hospital
by enabling them to access non-statutory support where required in order to live full and
meaningful lives. In the year 2018–19, the service supported 503 people on discharge from
hospital with 353 referrals made to community organisations in addition to 175 carer
signposts and 107 direct referrals to carer support services (Community Solutions
Programme end of year report 2018/2019).
Coordinators for Carers
Carers Together Carer Co-ordinators work across all GP practices in North Lanarkshire to
identify and engage with ‘hidden’ carers and young carers, facilitate access to the GP Carers
Register, and offer signposting and referral to appropriate support services as well as being
a reference point for professionals within the practices.
North Lanarkshire Carers Together also has Carer Information Workers described on the
organisations website as link workers who offer information and signposting to help carers
access local and national supports to help them in their caring role including information on
carers’ rights. The Carer Information Workers also attend local community events to help
identify hidden carers and promote the work of North Lanarkshire Carers Together, and work
77 https://www.inspiringscotland.org.uk/wp-content/uploads/2018/10/SiRD2021-Programme-Logic-Model-.docx
60
Draft v0.1
in partnership with statutory and voluntary sector staff to ensure carers get the best
information possible.
GP Community Link Workers
The Scottish Government has committed to funding a national Community Link Worker
(CLW) programme for this parliamentary period (up to 2021) with a commitment to recruit at
least 250 CLWs across Scotland during that time.78 Community Link Workers is
consequently one of the six key priorities that GP practices or clusters will deliver for patients
under the new GP contract.79 The Memorandum of Understanding aligned to this contract
defines the CLW as ‘a generalist practitioner based in or aligned to a GP practice or cluster
who works directly with patients to help them navigate and engage with wider services, often
serving a socio-economically deprived community or assisting patients who need support
because of (for example) the complexity of their conditions or rurality’.80 The service will be
designed, commissioned and delivered locally by HSCPs in collaboration with local GPs and
community based services including the third sector so that service configuration may vary
dependent upon local geography, demographics, needs, demand and resources. NHS
Scotland's Public Health Network (ScotPHN) is supporting Health & Social Care
Partnerships (HSCP) and their partners to develop and implement Community Link Workers
locally with information and guidance on recruitment and selection, induction and core
training, data and information sharing agreements, the role of HSCP’s, standards and
governance, and monitoring and evaluation.81
Recruitment of 18 generalist CLWs to work within GP surgeries across Lanarkshire
commenced in December 2019, nine of whom will be appointed for North Lanarkshire; a
programme co-ordinator is already in post within the Primary Care Improvement Team
together with two regional co-ordinators to take responsibility for coordinating the service in
North Lanarkshire and South Lanarkshire. At the time of writing, work was underway to
progress implementation in Lanarkshire82 involving development of the work programme and
service model including referral pathways, community resource mapping and induction
training for the CLWs (Carla Maxwell, Community Link Worker Programme Coordinator,
NHS Lanarkshire, Personal Communication, 17 February 2020).
78https://vhscotland.org.uk/wp-content/uploads/2017/06/Scottish-Government-Briefing-on-Community- Link-Workeres-30-May-2017.pdf79https://www.scotphn.net/wp-content/uploads/2018/08/Paper-1-Policy-Context.pdf 80 Memorandum of Understanding 201781ScotPHN CLW Support, Information & Guidance https://www.scotphn.net/resources/community-link-workers-support-information-guidance/clw-support-information-guidance-2/ 82http://www.southlanarkshire.gov.uk/slhscp/download/downloads/id/218/ south_lanarkshire_integrated_joint_board_meeting_papers_18_february_2020.pdf
61
Draft v0.1
Specialist link workers (SLW) who can offer specialist advice and casework on a range of
social welfare and financial problems and, when necessary, connect patients to sources of
support in their community, is another element of non-clinical support that HSCPs can
embed in general practice under the MOU requirement to provide CLWs.83 In this model,
which is already being implemented in some GP practices in Scotland, SLWs are employed
and managed by the third sector or local authority advice services accredited under the
Scottish National Standards for Information and Advice Providers, registered with, and
regulated by, this will be implemented in Lanarkshire with procurement of SLWs through
Citizen’s Advice.
A data and measurement plan (2020—2021) is being developed to evaluate the impact of
link worker roles within the CLW programme in Lanarkshire based on the theory of change
for the national CLW programme developed by Health Scotland (Helen Alexander,
Evaluation Manager, NHS Lanarkshire, Personal Communication, 17th January 2020). The
plan, in draft form at the time of writing, defines process and outcome measure in relation to
the generic (Wellbeing and Social Prescribing) Link Worker role and the Financial Link
Worker role. Data collection will be ongoing and enable presentation by area for North
Lanarkshire and South Lanarkshire and by locality, GP Cluster and GP practice.84
4.3.5 Commissioned services
Routes to Work Specialist Health Case Workers
Routes to Work Ltd is a third sector charitable organisation and a well-established Arms-
Length External Organisation of North Lanarkshire Council that supports local people to
progress to and access employment as a means of sustainably improving the quality of life
for individuals, families, and communities in North Lanarkshire. A review of Routes to Work
that examined the benefits from operating at arm’s length found that its charitable status was
highly valued by clients and its perceived separation from the council means that many
clients feel more comfortable accessing its services.85
Routes to Work established a specialist team in 2018–19 to work in line with Scottish
Government’s No One Left Behind plan by focussing on the areas of health, justice and
housing and homelessness. In relation to health, a Specialist Health Case Worker offers a
person-centred service for people facing significant barriers to work in terms of health and
deprivation to enable them to improve their health and wellbeing and progress towards
83 Specialist Link Workers (Welfare Rights Advice) in General Practice 2018 https://www.improvementservice.org.uk/__data/assets/pdf_file/0017/9710/hscp-briefing-welfare-advisors-general-practice-mar18.pdf84 NHSL Draft Link Worker Measurement Plan 28/01/2020 85 ALEO Review of Routes to Work Ltd. 2019 https://mars.northlanarkshire.gov.uk/egenda/images/att91717.pdf
62
Draft v0.1
employment. As well as self-referrals and internal referrals from justice and housing
specialist service colleagues, the service takes referrals from various external agencies
including social work and community mental health services, including referrals from SAMH
GP Link Workers (Specialist Health Case Worker, Routes to Work, Personal Communication
16 December 2019). Case workers have regular meetings with each client to understand
their needs and provide tailored support including referral to justice and housing specialist
service colleagues and external agencies within the service’s provider framework, as well as
ongoing encouragement to sustain engagement to help them achieve their personal goals.
Every individual’s progress is monitored using a Hanlon Software Solutions information
management system to collect data including demographic and other individual
characteristics, referral source, barriers to employment, engagement with supports and
progression towards achieving personal outcomes; service performance reports can be also
generated from this database. A key distinction between the specialist health case worker
service and Routes to Work’s standard support service is its focus on addressing the
complex social needs of people who are ‘furthest distanced from work’ due to living in
situations that are detrimental to their physical, mental and emotional health; and this is
reflected in lower performance targets for getting individuals into employment in favour of
evidencing what the individual has achieved in terms of ‘the distance travelled’.
63
Draft v0.1
4.4 Stakeholder perspectives
4.4.1 Statutory providers
Social prescribing as a concept
Understanding of social prescribing within the statutory sector in North Lanarkshire is
generally viewed as being uneven.
“If you’re talking about the senior leadership team and the core team in North Lanarkshire Partnership...I think there’s a reasonable level of knowledge – in very basic terms – around what social prescribing is.” (Interviewee 6)
“…generally, throughout all of the services, I’d say it was fairly mixed” (Interviewee 5)
“I don’t think it is particulary well understood on the local authority side, and within the health side I think its patchy” (Interviewee 1)
Familiarity with the concept of social prescribing is seen as broadly associated with particular
areas of work and especially mental health care, which is consistent with the earlier adoption
of the biopsychosocial model of mental health more generally. In primary care, it was felt
there was reasonable acceptance of the concept among GPs but also accounts of
unfamiliarity within wider primary healthcare teams. NHS health improvement practitioners’
greater understanding of social prescribing was often mentioned.
“Social prescribing is pretty well embedded within the mental health side of things, we are well used to the concept of working with all sorts of things…we have always thought of a biopsychosocial model as being our way of thinking about things” (Interviewee 3)
“I think the ideas are well received by GPs, the GPs certainly that I talk to are comfortable with the concept” (Interviewee 3)
I’ve been asking if people thought [non-clinical interventions to reduce the use of medication in general practice] can be achieved…but even the question, people looked at me as if I’m mad; I do think there’s a huge disconnect between the—not the health improvement side of the NHS—but other aspects of health provision and social prescribing” (Interviewee 1)
The agency of individuals however also transcends professional categories; that is, those
who adopt a social perspective and the ethos of social prescribing in the way they work
through personal conviction whatever their professional role.
“If people doing my role were a health professional…with a particular skill set and a particular way of training they might not see it the same way, and I know my colleagues who are also social workers that do the same job as me, I don’t think they’ve got into this at all" (Interviewee 1)
Language and meaning
Many of the expressed views on the term ‘social prescribing’ chime with those already
documented by others as described in section 3.1.1. By seeming to place people in the role
of passive recipients of a service, the medicalised language of prescribing could be seen as
misrepresenting the fundamental principle of social prescribing to increase people’s control
over their own health and lives and rebalance the relationship between statutory providers
64
Draft v0.1
and service users. It was also clear that there is more to this than just arguing over
semantics.
“Sometimes we get ourselves caught in the language of things that make it sound as though it’s a ‘servicey’ response when it isn’t, and it shouldn’t be; and we perpetuate the sense that people need something given to them…” (Interviewee 2)
“…is it prescribing? It’s a passive thing, its power relationships, prescribing suggests I tell you to do something, I prescribe it for you; but that’s not the relationship that we want to generate …it’s difficult to get the right term, but we do need to think about it.” (Interviewee 3)
Failing to clarify meaning for everyone involved was identified as a real risk that could hinder
efforts to achieve a shared understanding and a rebalancing of the relationship between
patients and healthcare providers.
“…prescribing, people probably think of drugs or medication, so if you’ve not got the [prescription] pad and you’re not being prescribed to do it, what’s people’s understanding of that?” (Interviewee 4)
“…if we’re valuing communities, essentially if we’re saying ‘how do we help communities be strong, be supportive of each other, be able to recognise what contribution everybody has to make – by us using professional language, does that help or hinder that?” (Interviewee 2)
On the other hand, advantages to professional language were noted in relation to buy-in
from health and care professionals that could influence progress towards its wider adoption;
and underlining integration authority responsibility to ensure sustainable funding.
“But you need to have something [a name] that’s going to have buy-in from the professions and at the moment ‘social prescribing’ does have buy-in from the professions; if you told them ‘you’re not allowed to prescribe anymore, you have to assist people to connect’…it might just stop you being able to make the progress you want to make” (Interviewee 3)
“One of the important reasons to use that medicalised language is that it protects the funding round it because it’s got that pseudo-sense of ‘we’re doing this because it helps people’s health and wellbeing, which will help on pressures on other parts of the system, so that’s quite a legitimate reason to use some of that language, to protect the sense that that’s not somebody else’s responsibility, that’s our responsibility to fund and see that as a whole” (Interviewee 2)
Creating shared understanding
Lanarkshire’s Well Connected programme (section 4.3.1) exemplifies the local branding of a
social prescribing initiative using language that is more accessible to the community, which
has also made the service more familiar among care providers.
“…when we say social prescribing people probably stop and think ‘what is that?’; if you say ‘Well Connected’ people might realise ‘Oh, that’s what they mean about physical activity, the library and looking after your wellbeing” (Interviewee 4)
“…if you then talk about Well Connected people probably understand that a lot more because it’s more understandable in the name Well Connected – you’re Well Connected…I presume that’s why they went with a local name, to try and make it a bit more understandable and accessible for people” (Interviewee 4)
65
Draft v0.1
But local branding does not in itself guarantee familiarity across all parts of the health
service.
“Say you were- to speak to our health improvement teams, right away they’ll know what Well Connected is; if you were maybe to ask some of our social work teams, mental health teams, I think they would know quite quickly, but some of our other teams I’m not quite sure, I don’t know if it would be as quick for them” (Interviewee 4)
Informal knowledge transfer in the course of everyday collaborative working was identified
as a contributory factor to creating shared understanding of social prescribing: mechanisms
included engagement with the Health Improvement colleagues, cross-sectoral relationships
and shared learning within speciality and interdisciplinary teams.
“As far as my staff go, within my own service, I think there is a fairly high level of understanding of what it’s about…it’s just their knowledge of what’s happening round about them…there’s a bit about working with the professionals they work beside, health improvement staff etcetera, voluntary organisations they’ll come across, and it grows from there and we have team meetings and they share that” (Interviewee 5)
“…what [our local Health Improvement Advisers have] said to me is social prescribing is not just going to swimming or going to the gym, there are all sort of other things that people could do, green gyms, join all sorts of community groups, gardening groups and all sorts of things…so I’d be somebody who had a relatively narrow perspective on social prescribing in general but I’m sure lots of people are similar to me; I’m convinced now that that’s not the case – the broader we can be the better” (Interviewee 1)
Raising awareness
That a need exists to raise awareness within the statutory sector about what social
prescribing is, what it can offer and who it can benefit, was not contested but there are prior
considerations around how and when that is done.
“There is [more to be done about raising awareness]; there’s a tension in it about how we do that because if we file it all as social prescribing are we perpetuating that whole problem of professionalising it?” (Interviewee 2)
“…but we can’t promote it if we don’t fund it, or if it’s not funded in a range of ways, because if it doesn’t exist why would you promote it?” (Interviewee 2)
“…yea, I think there is [more to be done about raising awareness] but [social prescribing’s] not available is the problem…I don’t think we are equipped to do it the way we ought to.” (Interviewee 5)
There is also some work to be done around changing attitudes to the value of social
prescribing and whose responsibility is it to take account of the wider determinants of health
in the care they provide.
“There are the doubters out there…I think they would be marginally on top because you’ve got the traditionalists that believe in traditional models and some people just aren’t at that place where they can accept there’s another alternative…but I think it’s marginal and we’re getting there…” (Interviewee 5)
“…how do we get our wider teams to think about what’s out there for people…because people say that’s not my role, not my job” (Interviewee 4)
66
Draft v0.1
The challenge this presents in the face of rising demands and competing priorities combined
with fiscal constraints is clear and should not be overlooked in the judgement of ostensible
negative attitudes to social prescribing.
“…that bit about the constant pull to the immediacy of the crisis…the ability to then say ‘no, we want to take a step back and do something that would stop so many people going to the hospital in the first place’ is really hard” (Interviewee 3)
“[There are] all sorts of pressures at this time of year on A&E and that just takes a grip of everybody and when you have that dynamic everybody’s perspective changes so you cease to think about ‘why are all these people at the hospital in the first place… maybe if people took a bit more care of their own health they might not have that particular issue that’s bringing them to the door of A&E’ so the two things are going on in people’s minds at the same time: I don’t think there’s a scepticism of the value of the social prescribing approach…it’s more that they would always privilege the traditional medical model, I’m convinced of that” (Interviewee 1)
“It’s about winning people’s minds over and saying ‘Right, ok, I see the validity in that’: that’s where the doubters are…particularly when you’re working at the clinical coal face you’re running hard to stand still and trying to get the work done.” (Interviewee 5)
There was some concern raised about the risk of wider opposition, which underlines the
importance of a shared understanding of social prescribing among all stakeholders.
“What worries me slightly is…I think we run into some opposition from the partnership, so from the Union side of things I have heard that sense of ‘if we start putting resource across into the independent and third sector then that’s a form of privatisation; we’re taking work away from the statutory side and putting it into these slightly loose arrangements where people maybe won’t have the same terms and conditions’…so it’s akin to privatisation would be the opposition to it.” (Interviewee 3)
Strategic thinking
North Lanarkshire’s partnership strategic plans and the processes through which they have
been developed reflect deliberative thinking about embedding core principle associated with
social prescribing, although seldom referred to using that term; and this is viewed positively.
“We’ve got really strong discussions happening about it on the GP side [going through the process of primary care improvement implementation and planning]…and as we get into those discussions its very natural to get into ‘and are there things that could be done in the non-statutory side to support and help people at an earlier stage before they need the requirement for statutory…’, in those strategic discussions it’s definitely there.” (Interviewee 3)
“One of the things I’m quite encouraged by is that we’ve tried to simplify [the Strategic Commissioning Plan] and make the message more straight forward and make it clearer what it is we’re intending to do…prevention and early intervention is right up there in terms of what people see as important, and how do we focus on doing that” (Interviewee 2)
“The structure around [the Plan for North Lanarkshire] is trying to embed the sense that this is everybody’s responsibility and we need to be more joined-up and we need to be thinking about the whole population and our collective diminishing resources…how do we increasingly make use of the resource that we’ve got across the piece rather just in their split up silos: now, the rhetoric of that is really good but actually doing it is much harder than it seems, not because people are not willing but because that’s not the way we’ve traditionally done things, and that feels like it’s a really positive evolution and will continue.” (Interviewee 2)
67
Draft v0.1
Investment dilemmas and decisions
When it comes to service delivery, decisions about funding social prescribing are
nevertheless strongly influenced by current resource constraints. Relative to pressing
demands on clinical care provision, social interventions are more likely to be low on the list
of priorities, which may to some extent reflect how they are perceived.
“The timing of doing the Strategic Commissioning Plan would say yes [social prescribing] does [feature in strategic or planning level discussions around service delivery] because we’ve really recognised that significantly within the drafting to date; and the most recent Mental Health and Wellbeing Strategy, social prescribing, the approach to recovery, is embedded in that, so yes people do talk about it and do recognise the importance of it. The crunch comes when you’re talking about limited resources, that’s where there becomes a more difficult debate” (Interviewee 2)
“…the problem and issue is everything’s a priority; if you’ve got high waiting lists and government pressures…our hospitals just now are in a very tense situation so the priorities will always go to the acute and the unwell and its always been finding that balance…” (Interviewee 4)
“When it comes to hard financial discussions its hugely difficult…that is a problem for us, there is a sense that some of this is a bit woolly and a bit soft and therefore it can be a bit of a soft target when it’s compared to some of the hard stuff that needs to be done”. (Interviewee 3)
One interviewee contested the lack of financial resources argument, with emphasis on the
words ‘decide’ and ‘priorities’:
“…the other myth of course is that there’s no money: a lot of our resources [allocation] you can’t pull out of…but there is always a margin and that margin is larger than many people think…that’s a lot of money around which we have to make decisions…people talk about a lack of resources [but] we decide what we spend money on and we spend money on priorities” (Interviewee 6)
Funding insecurity for the community and voluntary sector is recognisably a risk that
threatens to diminish the local provider base and undermine the notable advances North
Lanarkshire has already made through productive partnership working with the sector in the
development and delivery of the Community Solutions Programme.
“If you look at North Lanarkshire compared with other areas we have invested significantly [in our third sector through Community Solutions] however we’ve never been able to give that guarantee of ‘this is us, we’ve got two-year, three-year funding to take the work forward’ there’s always that…its unsettled, its unsure” (Interviewee 4)
“We’ve lost so many staff from our third sector organisations because we can’t give them the guarantee of one, two or three-year funding…extremely frustrating” (Interviewee 4)
It is also recognised that sustainable funding for community and voluntary sector providers is
the bedrock of a sustainable model for social prescribing.
“The other huge thing is that so many of the [community-based supports] that are on offer are on offer based on short term funding and with limited capacity or availability; and, it’s back to the money thing, about how do we shift this onto a more sustainable basis.” (Interviewee 3)
68
Draft v0.1
Wider healthcare system challenges
System-wide barriers and decisions enacted in the wider healthcare policy arena add further
complexity to the local decision-making environment, which can get in the way of developing
and embedding a locally appropriate, joined-up and effective social prescribing service.
“One of the interesting things about the way that we operate in a whole system is sometimes the Scottish Government decide to give money that actually makes that quite hard as well, the fact that some of the GP or primary care changes is coming with a very ’here’s this money and that’s how you’ve to use it’…you think, if we’d had a chance to do it a different way we might not have just gone completely down that route; so some of those tensions are very real and complex; because on the same hand the Scottish Government will be promoting third sector involvement and community empowerment so I just suppose it’s a demonstration of how complex the whole thing is. (Interviewee 2)
“You think about that [Scottish Government rolling out the national GP Link Workers Programme], where’s the capacity? So these workers are there and that’s great but the foundation below that…so if I’m one of those link workers and I’m referring to you as a third sector organisation, as a local group, you don’t have the capacity for all of this because you’ve not had that funding” (Interviewee 4)
Or is it complicated throughout the whole system that’s what I mean, like from Scottish Government right to communities, and Council’s layer in there and health boards layer in there and it makes it just hard to see how to do it; it’s not really solution focussed is it!” (Interviewee 2)
System-wide barriers are seen to impinge on local financial decisions and control over
financial resources in ways that have to be negotiated.
“Our systems are not easily designed around longer-term solutions…like not moving to longer term financial planning is a tension, not because people aren’t willing to do it, it’s because structurally there’s a sense that you do year on year planning because it’s based on Scottish Government settlement and stuff like that…there is a difficulty there” (Interviewee 2)
“The problem with this is the big-ticket items for health and social care partnerships are always around service delivery and particularly those areas that are national priorities and targets…” (Interviewee 6)
“That’s actually a huge problem across our whole public sector because the Christie Commission etcetera set out the benefits we would have by taking a preventative approach yet our entire system is calibrated towards dealing with fixing the bits that are broken rather than taking a preventative approach. I can’t see how you would do that without separating the money somewhere, you need to have a set of money that’s for fixing the broken bits and a different set of money that’s for taking a proactive and preventative approach. Social prescribing kind of fits in between those though, it’s neither one nor the other…on the fringes of fixing things but it’s not quite prevention although some of it will be: it’s an interesting debate…” (Interviewee 3)
Relationships, reliance and trust in the community and voluntary sector
Achievements in building working relationships with the community and voluntary sector in
North Lanarkshire are viewed positively and there is trust expressed in the sector as a
dependable delivery partner as well as an unequivocal recognition of dependence on it.
“We’ve just done a load of engagement session round our strategic plan and at every single session and locality it was spoken about the work of the third sector and the relationship between our third sector and statutory organisations and over the years this is coming so much closer than what it was before” (Interviewee 4)
69
Draft v0.1
“In terms of our long standing relationship with VANL, third sector, I think our recognition of the role that they have and the structure around their engagement with communities is one of the things that has worked well in North Lanarkshire; and things like local people coming together with support through VANL to make decisions…local people identifying [what the issues are] and doing something about it” (Interviewee 2)
“Yes [there is trust the community and voluntary sector as reliable providers]. I think it’s more of necessity; the independent sector [sic] now provide services that either didn’t exist or that people needed or [that] used to be provided by statutory services. Aye, there’s a very strong relationship of trust. And VANL…they’re key partners in everything we do.” (Interviewee 1)
“I think [statutory providers] do [trust the community and voluntary sector to be reliable providers]…and there’s a number of things that voluntary organisations can do that we can’t so there is a dependency and we definitely need them as partners, and trusting that will continue because…we couldn’t survive to support people out there if we didn’t continue to fund them: aye, there will always be a place for voluntary organisations, always. (Interviewee 5)
Evidence for investment and evidence of success
The difficulties inherent in establishing the evidence for the benefits of social prescribing
hinders evidence-based decision-making about investing in it; and expectations differ on the
level and type of evidence that would be sufficiently convincing.
“One of the other aspects particularly of social prescribing and taking a more preventative and proactive approach is how can you say for certain that what you’ve done there has this effect over here, you can’t say for absolute certain…or how do you know what you’ve done here has offset a range of things that haven’t happened, that’s even harder to show that; so inherently I think the things [for which] you can say ‘that money has bought that many clinical appointments or residential home placements or individualised support that has resulted in this number of people being supported’ that’s easier to understand; but this bit of work which might have touched 50,000 people, which might have helped the general wellbeing in this community, is harder to quantify” (Interviewee 2)
“…particularly GPs, I think it’s important that they can see there being evidence it can promote health change and health benefits; I think GPs tend, for good reason, to be much more empirically driven and look for hard evidence for things” (Interviewee 1)
This is also evident in relation to evidence of economic value:
“I do wonder if what you really need…is would you need an NHS economist to say this is a cost effective way to deliver a health service; it would give it a credibility as well” (Interviewee 1)
“…because of the pressing issues we have round resources, delivery plans, the enormity of the problem…if your core services are potentially going to be cut and you [want to] invest in something that’s going to show some profit or return in ‘x’ number of years, people will have doubts and that’s essentially where we are” (Interviewee 5)
I think what we do is we actually force people to take a very good idea but the only way it gets heard is if you tell people it’s going to save money: ‘I can’t go to SLT who are looking at financial savings and a whole pile of other things and say please start doing this because it’s better’, which is the right thing to do, what they have to say is ‘if I get a little bit of money this year you will save so much more down the line’ (Interviewee 6)
The stakeholders questioned also expressed a range of views on what persuasive evidence
of success would look like. Benefits for people were notably seen as being paramount:
“The most important thing is that the person themselves has got a feel-good factor” (Interviewee 5)
70
Draft v0.1
“There’s some people like me who would think, if you’re going to a GP for antidepressants the fact that at the end of the day your social circle has improved and you’re less lonely or whatever is a good thing…ideally they would be able to reduce your medication…but even if that’s not the case at least someone’s outcomes have improved” (Interviewee 1)
“…if my patient’s telling me ‘I went along to that community group and I feel so much better, I’ve made friends, it’s nice to know I’m not alone’ and they go off and they’re empowered…for me, that would be the biggest influence; [narrative] feedback you get from patients or from staff about a patient’s state of wellbeing and reduction in need for medical intervention…on a [GP] practice level, is probably one of the most powerful things” (Interviewee 6)
Benefits for healthcare providers included a change in attitudes towards social prescribing as
well as anticipated benefits commonly mentioned in the literature such as having more
options and reducing workload.
“The big thing for me is that we all have that knowledge and we all believe it’s got a place…you need to believe that it does make a difference, that it’s important” (Interviewee 4)
“…and softer things like a GP having at their fingertips the ability to access a variety of resources easily, so it’s easier to refer someone into a social prescribing route than to write a prescription or refer to another professional” (Interviewee 3)
“If we manage patients differently than what we’re doing just now, and the outcomes are evident then the clinician or social care worker would see the benefit of it, and if it is assisting them with managing their case load, managing that person, then I think that would be the convincing factor for them” (Interviewee 5)
In relation to benefits for the healthcare system, there were divergent views on the absolute
need for quantitative evidence of reduced demand at the system-level.
“In a really simplistic sense, from a system point of view, social prescribing would be effective if there was less pressure on referral for more specialist services…so if you think about CAMHS and supporting young people with mental health difficulties, if a wider range of options is available for people at an earlier stage in terms of young people and their families feeling connected and valued in their community and valued as people then the logic would be that the number of people that experience psychological difficulty should reduce but the people that have got a need for specialist mental services for children [those] services will always be there, and if you get the people that really need it at the time then that would be a really good outcome. That’s ultimately the measure we would be looking for in the system we work in to make sure that response across the board demonstrates how it joins up and impacts positively” (Interviewee 2)
“When I look at the number of people who are referred for psychological therapy or CAMHS over the last 10 years I see a steady increase – success would be that that starts to flatten or drop; because there are such good alternatives out there…; I’m sure there will be other things you could look at…fewer people needing rehab for long term conditions, so a drop in the physiotherapy waiting list…” (Interviewee 3)
“At strategic level…you want something that works…the narrative stuff, for me, is probably the first thing, if you’re going to wait for a change in antidepressant prescribing you’re going to wait long and weary, if you’re going to wait for a change in hospital admissions you’re going to wait even longer…if we’re looking for that kind of evidence there are so many confounding factors [so] narratives, individual cases, individual success stories, very simple things…here’s a number of patient who were referred by their GP and four weeks later they’re still going to a particular class, a particular group…[evidence that] people are buying-in. How [should we] measure that? We don’t measure the number of consultations they have with their GPs, we don’t measure how many of them get admitted to hospital, we measure how many turn up and who turns up often; so in terms of evidence I think it’s very much keep it simple” (Interviewee 6)
71
Draft v0.1
What else we can or need to do to support social prescribing in North Lanarkshire
The stakeholders interviewed have confidence in HSCNL’s strategic direction but are alert to
the importance of making sure there is close alignment between delivery plans for its
statutory services and the Community Solutions Programme.
“Having this central to our Strategic Commissioning Plan is helpful, it’s a good symbol that it’s there” (Interviewee 3)
“It’s not just about the funding, it’s about breathing space and I don’t think any of us ever gets breathing space to look and see are [our strategies] aligned, do they sit ‘like that’ as you want them to sit as our delivery vehicle…there’s that time [the Community Solutions Programme Manager] and others need to stop and breathe and say ‘what’s happening over the next three years, are our programmes fit to deliver what they need to deliver over the next three years’. We just need to make sure we are going together.” (Interviewee 4)
The success and durability of Community Solutions is a credit to the leadership and
determination within the NHS, Council and Third Sector Interface in North Lanarkshire right
from its origins in the Change Fund, and it’s governance arrangements are highly regarded,
but ways have to be found to maintain that infrastructure and its financial sustainability in an
uncertain health economy.
“…the strength is there but to maintain strength you need funding, we need to know they’ve got bills to pay, they don’t get their lets, venues, everything free…” (Interviewee 4)
“…moving to three-year funding commitments, and doing a three-year Commissioning Plan steps us towards that” (Interviewee 2)
The implications of lack of oversight to ensure coherence and avoid duplication across all
social prescribing initiatives in North Lanarkshire that are funded and governed outwith
Community Solutions, including the various link worker roles, and how that might be done,
also warrants consideration.
“…and actually by funding them in that way…that part does that and this part does this, do you divide and weaken…or do you take all those bits and create a big monster of a thing that just becomes a bureaucracy in a different way…I don’t know the answer to that, it’s really a big tension” (Interviewee 2)
“In terms of the prevention and anticipatory care, the IPAC stuff, there is people who do look at that, but again the tension is do you have a group looking at employment, a group looking at poverty, a group looking at social prescribing, and actually what’s different and what’s the same about all of them? I think we’ve got to be careful not to assume that it’ll just happen but not to create structures that just stick things in boxes as well” (Interviewee 2)
Creating a new relationship between health professionals and service users has been
identified as an area for development, to make sure the ‘first point of contact’ has the right
conversations and connects people to the most appropriate source of support, which is
essential for social prescribing to work.
“One of the things we’re talking about now is that if somebody comes into contact with a member of our team is first point of contact, what is our response; our staff keep saying we do it but we have so many cases where people are saying I didn’t get the right response, help, I needed, so we need to create a different culture and if we use the principles of the 3 conversations, if we all adopt that approach hopefully [that will bring about] culture change; if I
72
Draft v0.1
pick up that call it’s up to me not other people, that’s what we now need to look at, us being in a Health and Social Care Partnership, lets really look at what’s within our gift to do, that is within our gift to do.” (Interviewee 4)
Having the new GP Link Workers in post will be an important enabler for social prescribing in the primary care setting.
“I do think that through the Primary Care Improvement Plan our development of the link worker model will be a helpful thing in increasing the visibility and the access to social prescribing across primary care, so that’s one thing we can absolutely do” (Interviewee 3)
There is also potential to harness the influencing power of professional leadership and
opinion leaders to change perceptions and encourage involvement of a broader range of
practitioners in social prescribing.
“I think what’s missing is…these conversations I’ve had with pharmacists, I think the local pharmacists are able to hook into this but that’s not part of their… trying to get that slightly broader perspective; to get that lever there probably requires getting the buy-in from the chief pharmacists and that type of person…if it’s the pharmacist who’s asking these questions it would be a good thing—doing it from the inside” (Interviewee 1)
Not knowing what supports are available is a commonly cited barrier to social prescribing
and making it easy to find out is a commonly cited enabler. North Lanarkshire is ahead of
many areas in having developed several useful resources but there is a need to consider
how to optimise their utility.
“Well Connected, that idea of bringing things [together] is a good idea, and whether some of the stuff we can do about improving Locator, or getting more stuff onto MLE, these different tools we have; somehow we need to make it easy for people to do what we think is the right thing, at the moment I’m not sure it’s as easy as it could be…I’m not sure that we have good ways of making sure that we are always aware of all the things that are available” (Interviewee 1)
“One of the problems from a SP point of view, one of the frustrations, is you’ll go out and speak to people who’ll say ‘nothing happens in Cumbernauld’. Nothing at all…are you sure? Then people have a debate about this happens, this happens, there’s this group and this group… richness of things out there and folk will say ‘I didn’t know about that’, so how do we equip people with that information…how do we start to get much more personalised responses in terms of how we quickly understand what the issue is for you or what your position is and join you to the right bits of information; so that’s a really exciting opportunity for us in terms of technology [that] changes it as much for practitioners and staff as it does for the public.” (Interviewee 2)
“I’m not sure that we have created the environment that encourages people with ideas to be able to put those into practice so, if I had the idea it would be good to do a park run or a walking group in my local park where do I go to get support to make that happen and get it onto the list of things that would be available for my GP to say to other people in the locality ‘here’s a good idea why don’t you do this’; so I think there’s a gap there” (Interviewee 1)
Feedback to referrers on the progress and outcome of the referrals they make is an
important gap in the capability of current tracking mechanisms.
“…I think having the feedback loop is important because that fosters trust over time; part of the problem might be say if someone refers a patient to a voluntary organisation or a community group, if the patient doesn’t come back and tell them that was great they’re not really sure so they’re not sure when the next patient comes in ‘should I do that again or should I not?’ ” (Interviewee 6)
73
Draft v0.1
And currently, North Lanarkshire does not have IT systems that would enable social prescribing activity and tracking to be managed across statutory services and community-based providers.
“We’re way, way off that; I couldn’t even put a timeline on that, when that would happen” (Interviewee 5)
Final words
“…and there’s the whole issue about Scotland’s health, we haven’t touched on what priorities should be like smoking, breast feeding which is a high priority, and there’s also diabetes…social prescribing…it just takes you into a different world” (Interviewee 1)
74
Draft v0.1
4.4.2 Community and Voluntary Sector providers
Language and meaning
Focus group participants agreed that ‘social prescribing’ is an unfamiliar term in the
community and voluntary sector. They were also agreed on it being ‘health service’ language
with advantages for the statutory sector including buy-in from health professionals but find it
is not always familiar to health care professionals they work with either.
“I asked two of my staff today if they knew what social prescribing is and they didn’t, ‘Is that a new terminology?’…it’s one of those things where there’s this assumption that everybody knows what it means but I had to kind of look it up myself not that long ago to see what it meant…so [I] would say knowledge is fairly low”
“It’s coming from the medical side, they’re trying to get the GPs to buy into it to make sure that they are not overwhelmed, so if they put ‘social prescribing’ on it doctors will probably buy-in to it more”
“You think when you talk about a prescription, something the doctor prescribes for you, they give you something…we advise something for you to help you feel better, so whether that’s a medicine or an activity…they’re still putting you on that path to make you feel better”
“I think it’s important it does have a name for more clinical sides to say that healthcare is changing, it’s getting more holistic, but I was speaking to a nurse today and they didn’t know what it was, when I explained they said that sounds really good…they followed it”
It is clear however that the concept of social prescribing is nothing new to the community
and voluntary sector: they recognise it as describing the principles that underpin the sector’s
everyday way of working although they don’t call it social prescribing, and that terminology is
not necessarily well-liked.
“It doesn’t mean that it’s not happening, it’s just we don’t use that terminology; I think it’s a horrible term…”
“I think for the majority of us we’re already doing it… we’re just not putting that tag to it.”
“I think we have been doing this for a long, long time but now the GPs are seeing that it’s a really good way of working”
‘We’re already doing it’
Further discussion elucidated what community and voluntary sector organisations mean
when they say they are already doing social prescribing. Although the word ‘signposting’ was
often used as a ‘catch-all’ term it does not adequately describe the spectrum of activity that it
is being used to describe and could, therefore, be easily misunderstood to mean much less
than what is actually happening in the sector.
“…and you’ve just said the word again there, ‘signpost’, I’m sure everybody in this room’s the same, it’s not just going ‘there’s a group you want to go to’…”
“Much more than that…”
As well as signposting in the sense of giving information or directing people to relevant
resources where appropriate, and delivering the community-based services and activities
commonly associated with social prescribing, many voluntary sector providers inherently
75
Draft v0.1
perform a ‘link worker’ function in the way they work with people, taking a holistic approach,
having “the conversation”, identifying wider needs, directly connecting people with other
services and activities, and supporting those who need it to access and engage with those
services and activities. Many organisations offer support at more than one level depending
on the needs of the people they serve.
“…we find that all the time, we get people phoning us up, ‘I’m a carer’, wanting information and you listen to them and you go ‘I think there’s something more here’ and you say ‘why don’t you come and meet with us’ and they’ll come in…basically they’re looking for a solution to something then they start to open up and there’s all these other things…layers and layers”
“…not just the person the whole home environment you’ll take into consideration, if there’s other siblings in the house, if there’s addictions, then there’s that bit about ‘what else can I link people in to?’”
“It’s potentially physically taking them there, arranging transport, checking in with them ‘how did it go; are you going to go next week?’ It’s not just saying there’s a group you can go to…if somebody’s really quite isolated of suffering from anxiety or poor mental health issues to actually ask them to walk into a new group – it’ a big task…even getting on a bus…”
Community and voluntary sector organisations generally do not see this holistic approach
happening in statutory services.
“[with GPs] there’s prescription or referral to mental health services…there’s not that kind of bigger picture of thinking: we’re getting the full picture, how are you meeting the needs of your kids, how are you managing with the house, food, budget and things and then from that you’re [connecting them] to CAB and HOPE [for Autism] and everywhere…”
“On an initial visit the other day just to gather information from a mum, I know straight away that she’d got no food, I’m contacting the welfare fund, waiting half an hour on the phone, and had to go back and get social work on the phone who weren’t interested because we’d provided that service but didn’t see the bigger picture…of mum’s anxiety and depression…’youse have provided food for her so that’s fine’ ”
What is more, community and voluntary sector organisations are often doing this while ‘filling
the gap’ as people wait for access to statutory services.
“I think even looking at time for appointments because one of our families, suicidal and things, [waiting for] a GP appointment weeks down the line, so you’re in action – who can I refer you to, Cruse Bereavement Care…what can I get you?”
“Your biggest problem is now social work picking up, I’ve been waiting since October for a family I referred in with massive issues and they’ve still not allocated a worker and from there I’ve referred mum to x, y and z just to fill in the gaps because social work just aren’t picking up…”
“We’re doing all the social prescribing whilst you’re waiting for that”
It is not having more time available or spare capacity that explains this way of working it’s a
mindset, and many community and voluntary sector providers add more intensive support
provision to their role informally.
“…and it’s not because we’re not rushed off our arses…it’s because we see the need and we see the desperation and we’re prepared to speak to people quickly”
“You’re going above and beyond what you’re commissioned to do because you will not see that person [left] high and dry”
76
Draft v0.1
“…and it’s not my remit to do this, but I went because I knew it was important to go to a walking group with her, I went twice, got her to meet and chatting to people and, it’s two years now, she’s still going to that walking group; so, see, it’s just a small investment for people, if they just have that confidence to attend, or phoning up to make sure…because it is a big step if you’re not used to it”
“We’d be in a sorry state if we stuck to what our remit was”
Being well-placed to do it
Community-based organisations feel well-placed to do social prescribing, and that they are
seen as being more accessible to local people, more likely to be responsive, and less likely
to be judgemental; and to reach people who won’t necessarily seek help from statutory
services, even their GP.
“Social Prescribing is happening at the moment, we’re doing it and we’re really well placed to do it and it shouldn’t be less valued because we’re doing it as opposed to clinical services doing it because we’ve got a better understanding, better relationships with people that need these interventions.”
“…and the thing is the third sector is much more accessible to them so if you try to get hold of a doctor or someone in the third sector you’re more likely to get hold of us and we’re more likely to step up to the plate quickly when you need it…”
“But then people also…they still tell us that in terms of statutory services they can find that really off putting too so what you tend to find is somebody could sit with us for an hour, two hours, and really open up; they’ve phoned you for one thing and before you know it you are looking at everything holistically and you’ve maybe got a dozen different referrals and all of a sudden that person’s on your radar where they wouldn’t necessarily go to the GP, especially carers don’t, they’ve no got time for that so they probably won’t end up at the GP in the first instance, there’s more chance of them falling into one of the third sector organisations and carers have said to us ‘I feel that there’s no judgment’ because there’s that perception with social work still, you know, ‘I’m no going to tell you I’m struggling, you might take my kids away’ or ‘you might put my mother in home’ ”
“You tend to find with the social prescribing that it comes naturally to us because conversation flows naturally when they engage with you…”
Partnership working and feeling valued
HSCNL is viewed as being ‘ahead of the game’ when it comes to working in partnership with
the community and voluntary sector as exemplified by Community Solutions; but a persistent
disconnectedness is experienced in practice that may be understood in terms of having
unequal status in the partnership.
“What has to be said is that in North Lanarkshire there is really good partnership working within health and social care and the third sector, that goes without saying in terms of all the Community Solutions work that’s going on”
“I think health and social care see the value of the third sector but there’s still some of the dots still not joining up: it’s bizarre how it doesn’t work when you think about the number of events you go to, the strategic planning groups where you’re sitting with health and social care and you talk about the job that you do and how, for us, it’s about reaching out to the families, providing information, you know, we provide case studies about what that’s done for that family and they look at you as if to say ‘that’s amazing, where have youse been?’ but then you hear nothing. So you get the vibe that certain people really understand it and want to buy-in to it but I don’t know if there’s just that hierarchy…”
77
Draft v0.1
There is also a sense that statutory healthcare providers ascribe lesser value to what the
community and voluntary sector do compared with clinical services; and can fail to recognise
that this is often a strength.
“There are a lot of places that do value the voluntary sector and Lanarkshire as a whole is much better that other Local Authority areas but there is still a divide between clinical and non-clinical”
“I work quite closely with the NHS Health Promotion Team, who are great, but I’ve had to do quite a bit of work with clinical staff from the Sexual Health Team and there’s very much of a difference there, it’s taken me a long time for them to value what we do, what we bring in, and these are people I have worked with for over 15 years and I’m still sometimes blown away by their flippant remarks about our service”
“That was…we weren’t really valued…because we weren’t clinical”
“But it’s the fact that you weren’t clinical that made that [project] work.”
There is clearly a willingness to work in partnership but as equal partners within HSCNL,
with appreciation of what each partner organisation has to offer the others in order to
maximise the contribution that each can make to achieving shared goals.
“In the voluntary sector we see networking as a big part of our job, we don’t work in isolation we work together and that’s how we can make the strides that we make, is by tapping into other people’s expertise…but the statutory services work very differently, it’s very much like ‘we don’t need you’ although in North Lanarkshire it’s much, much better than it is in other places in Glasgow, here you’ve got a good chance of getting somebody from health round the table to sit and speak to you or join in a conversation…so there is a willingness to work [together] and I really feel like the voluntary sector is valued in North Lanarkshire by NHS Lanarkshire especially different departments but whether that feeds down to GP services I’m unsure”
“To be fair GP practices are changing, they are piloting a lot of different posts, so the referral to CAMHS, referral to mental health services, they know that it’s really long, it’s terrible how long it is, but they’re having now a psychiatric nurse in the practice so they will assess the situation so the family or the person can get support sooner, or if they think it’s appropriate they’ll refer on or refer onto community services; we need to acknowledge that there is a lot of good work being done and I think it’s just trying to collaborate and trying to work together as equal partners”
“Because when it does work, you’ve got examples coming out your ears, when it works it’s amazing…and it is all about these preventative measures and getting people out the house and reducing isolation…we’ve all got the same goals but we just need to get better at statutory talking to us”
Supporting more social prescribing
Expanding social prescribing activity in the statutory sector can reasonably be expected to
result in more referrals to community and voluntary sector service providers. Some increase
in referrals already being experienced in North Lanarkshire is attributed to increasing
dependence on the sector given financial constraints in statutory sector budgets. This
exposes potential negative implications for community-based providers, and the service as a
whole, if more referrals are generated by expanding social prescribing activity in the
statutory sector unless steps are taken to prevent them from happening.
78
Draft v0.1
“…and what we’re noticing as well is not even just the amount of referrals that has really ramped up but [they are] often inappropriate, so it’s almost as if ‘well it’ll get it off my desk so I’ll fire it over to you’: there runs the danger, and I suppose that’s where I would be wary if we go down this, social prescribing, is that it’s just a case of ‘well, we need to get it off our desk so who could we punt in onto?’
“Then you’re messing that person about by saying this isn’t the service for you…”
The importance of embedding ‘first point of contact’ practice principles in social prescribing
initiatives is plain to community and voluntary sector providers and, from their own
experience of statutory provider attitudes, they appreciate how challenging that can be.
“…and as you say, that’s then bringing in other organisations that are unnecessary; certainly everybody around the table are working with vulnerable families and so it’s about regardless of where these families present themselves, it’s about the individuals making a bit of judgement…it’s looking at everything more holistic and not just looking at the wee bit of work that you do, where you expertise is, it’s about looking at everything so that regardless of where that person fits in they’re still getting the social prescribing”
“A while back…when there was a big push on GIRFEC I did quite a lot of training for GPs and pharmacies, because the idea was that it wasn’t just your teachers, janitors, lollipop men it was everybody’s issue…the people who were there didn’t really want to be there…I did feel there was this clear barrier of ‘that’s not our job’; but when I walked into that room I had the assumption that they’d all be on board and it wasn’t like that, it was very much ‘this is something else I have to do’ ”
Grave concerns were expressed about lack of investment to build and sustain the
community provider capacity required for staff and volunteers to feel able to support social
prescribing; even within Community Solutions where financial insecurity threatens capacity-
building provided through Locality Consortia as well as provision of community-based
services and activities.
“I know through a number of groups that we fund [through the Locality Activity Fund], they’re saying ‘we’ve had the referral in from the Community Mental Health Team, we’ve had the referral in from the GP’, we’ve had an example where they’re saying ‘we’ve had 12 referrals from the GP in the past two months’; you’re saying that’s great but then you’re struggling for finance so where are you going to get the finance?”
“They can’t just refer on people to the voluntary sector because the money’s not there: [Community Solutions] for example, we don’t know what’s going to happen after June, we’ve got the first quarter [funding] for the next year to fund groups but I’m thinking if I give out funding to that group they still rely on [the Locality Consortium] to give a bit of support but what’s going to happen if we’re not there to support those groups who depend on that input, what’s going to happen when that money’s gone?”
“…we’re already struggling, not even just the organisations that are paid to deliver a service, even the groups that Community Solutions fund, you’re relying a lot of the time on the good will of volunteers”
“…an example, Elim Church in Motherwell, fantastic group, we’ve funded them a few times [through the Locality Activity Fund]…the Community Mental Health Team are referring people in there, the volunteers are getting free training through VANL or other organisations like Equals Advocacy but it’s going to get to a point where it’ll still be the same number of volunteers there but more people will be coming through the door and more complex people [so] there’ll be more training needed. It’s that thing about ‘we’ll just refer onto them’ and not looking at the impact that that’s going to have…Elim…volunteers are doing fulltime hours”
79
Draft v0.1
Models and menus for social prescribing
As with the term ‘social prescribing’, community and voluntary sector providers see the idea
of developing a model for social prescribing as coming from and having advantages for the
statutory sector such as securing buy-in, facilitating implementation and it “being
measurable”.
“I feel that this model’s more for the clinical side, I really do”
“…and really, should we have a model or should we be thinking about [the person]…we need this/that model, no, somebody needs help, what can you do there and then on the spot with what you’ve got, and if I’ve not got the answer who do I contact?”
“…and I know exactly what you were saying there about the model thing, and mostly agree with that, but I think sometimes if there’s a model it might be easier to get more statutory services to buy into it; as the voluntary sector we’re all quite used to working like this, we don’t need to have a prescriptive model but when you go to different disciplines like doctors, GPs, it might be easier to implement…”
The importance of funding for sustainability was underlined:
“…and, equally, funding, if they’re wanting to put models in, I know from running different projects, if I’ve only got a year’s funding a lot of people don’t refer in because they just think it’s going to go; so we need to be working much more longer term to set these services up…funding is important if they’re creating these models”
The concept of offering a menu or list of options for people through social prescribing does
not fit with community and voluntary sector providers’ understanding of social prescribing as
a person-centred, assets-based approach that gives people choice to decide which services
or activities can improve their personal situation and enable them to take control over their
own health and lives; or their experiential knowledge of the range and complexity of needs
they see within their local communities and the individuals and families they support, and the
wide range of supports they know are locally available. Over reliance on a menu that is not
comprehensive, therefore, risks undermining inclusivity as well as underutilisation of local
assets.
“Should there be a menu…how’s the menu going to look…it’s going to be huge”
“…it’s no different from having a bunch of leaflets out”
“…and also excludes so many amazing organisations”
Concern was also raised that some statutory providers, lacking the depth of local knowledge
that community-based providers have about what local services offer, might simply use a
given menu prescriptively.
“If they’ve got a menu in front of them are they going to say ‘Oh, there’s physical exercise, ok [this organisation] is one that gets used all the time’ because they don’t know what’s involved at each service, so that’s not going to work as there’s no in-depth knowledge of…no linking up the activity and the person, there would need to be more…it’s not just ‘Physical exercise, there you go, it’s the first one there [on the menu]’ ”
The desire to designate approved providers is understood but a downside of a menu for
social prescribing is if some community-based organisations are seen to be approved
80
Draft v0.1
providers and others, possibly leading to less investment in organisations not on the menu;
and raises the notion of mistrust in the sector as reliable delivery partner.
“…the liability thing is quite important, that’s perhaps an element of distrust between the clinical side and the third sector”
Focus group participants sounded a note of caution regarding reliance on North Lanarkshire’s Locality Profiles as the indicator of local need to inform local provision of social prescribing, because that could “promote your postcode lottery” with the risk of increasing inequalities, fail to address the range of problems that people seek help for, and put some providers of valued local services at a funding disadvantage.
“I know they’re there and they’re probably useful for something but whoever presents in front of me you deal with what’s happening with them…”
“Often they can be a precursor for funding, it shouldn’t be like that”
GP Link Workers Programme
Drawing on the richness of experience within the community and voluntary sector in
Lanarkshire, views shared on the introduction of GP link workers stressed the importance of
people skills and local knowledge for successful social prescribing link working.
“…in order for the GP, for social prescribing to start there and for it to work well, they need to have an understanding of absolutely everything that’s going on out there…I don’t think that the knowledge is there so I think in order for social prescribing to work these new link workers that are coming into post that’s the trick”
“…if we don’t know what’s out there we can’t do our job and that’s going to be the absolute key bit for these link workers, not just to know there’s an organisation called [name]… they need to know who we are and what we do”
“…if these GP link workers are going to work they need to have the knowledge and the understanding of who does what out in the community so that they can confidently have that conversation with the person”
“…see if you’re a people person, chatty, make somebody feel at ease, you’ve more chance of somebody opening up and working with you to find alternative things that they can do whereas if you’ve got somebody who’s quite clinical you can see people being like ‘I’m just no gonnae tell them my problem’ ”
“I know some nurses that are classed as clinical and they’re amazing…it’s not so much pigeon holing people as clinical or not it’s having the right skills and background to liaise…”
And emphasised link worker capability to tackle barriers related to the attitudes of practice
staff to the value of social prescribing.
“They’re going to have to influence quite a bit of change; they have to buy-in to it, know what they’re supposed to be doing but also have that willingness to push change not just to sit back and say ‘OK, I know it’s not your job but I’ll no say anything’ ”
Questions arose about integrating the new GP link worker role with existing link worker
initiatives; and attention was drawn again to the risks of not adequately funding all parts of
the system, including the risk of undermining the principle of strengthening community
capacity.
“There’s these link workers coming through the NHS Health and Social Care Partnership but we already have link workers through SAMH who’ve been up and running 3 or 4 years,
81
Draft v0.1
they’re still going to be there but they’re under the third sector and you’ve got these guys coming in from the health, how’s that going to work?”
“…the health link workers are going to have better pay and conditions and holidays, sick pay and all the rest of it. How are they going to balance that out…or is it that people from the third sector are going to go over to health?”
“Look at the amount of money that the GP link workers is going to cost…you can’t just stop there, what investment’s going to be put in place so that we are able to keep delivering these services?”
Community and voluntary sector organisations express a strong willingness to share their
local knowledge and experience with GP link workers newly in post, work together towards
shared goals and share learning.
“We all share…in Lanarkshire everybody wants to share, it’s quite good that way”
“…it would be good to find out how they’re getting on and what barriers have they come across”
Social prescribing for children, young people and families
As noted in sections 3.1.2, most of the attention on social prescribing to date has
concentrated on adults. An informal discussion with members of North Lanarkshire’s
community and voluntary sector thematic network for children, young people and families
revealed a wealth of local expertise so focus group participants were asked specifically
about their views on approaches to social prescribing for this population.
Referral routes into social prescribing for children, young people and families should
encompass health and care services and other organisations they are most likely to come
into contact with including primary as well as high schools, which were seen as especially
important particularly in relation to early intervention. Health visitors, family planning clinics,
sexual health clinics and social work were among the health and care services mentioned,
and many community and voluntary sector organisations are proactive in building
connections with local statutory services to create local referral pathways.
“For young people I’d be looking a family nurses and high schools and things, to link them in so they’re aware of services because young people don’t tend to go to their GP on their own, it’s usually dragged along by their mum, but if we actually look at [linking] to nurses that are in high schools that would be really good”
“We’ve great links with the health visiting team because [we work with parents of] under 5’s, so we have that link direct and that’s where the majority of our referrals come in from; [we] went out and spoke to health visitors so we took responsibility for raising awareness”
Mechanisms for community and voluntary services to refer people back to statutory services are generally inadequate.
“It’s [relying on] faith in the services picking that up, to get an appointment…”
Discussion touched on particular social difficulties affecting children, young people and families in North Lanarkshire and where gaps in support services are most evident, and foremost among these was mental health.
82
Draft v0.1
“Financial’s always a biggie, housing, for me; and [for] young people ours is resilience…being able get back up again when you’ve been knocked down…I work with very vulnerable young people and some of them have to have resilience to be standing in front of me but how many knocks can you take; or you’ll see others with less resilience they’re self-harming, they’re maybe substance misusing, self-medicating with other things…resilience for me’s a biggie”
“Lack of provision for children with ASNs [additional support needs]…our phone calls always ramp up just before school holidays…there’s a huge lack of provision; even befriending… befriending is massive”
“Youth work resources have just been cut and cut and cut, you speak to any youth worker in North Lanarkshire, it’s desperate, and ASN provision among youth workers is even worse, there’s nowhere for kids to go; social isolation and mental health are huge issues”
“I think sometimes [social prescribing] models need to be relooked at… there’s so much physical activity services, a huge amount, but there is a gap or it’s not balanced with nutrition and food, we need to make the ‘food and mood’ link to mental health”
For many, being unable to afford childcare is an important barrier to participation in community-based activities and could, therefore, be a barrier to benefiting from social prescribing. It was thought that more families would benefit if social prescribing could offer free or low-cost opportunities for families to participate in activities together.
Final words“Social prescribing, sometimes it would be nice if it was something to break the monotony, a wee bit of fun, something to lift somebody’s spirits…especially if you can do it as a family”
83
Draft v0.1
4.4.3 Public and service user perspectives
Direct engagement with service user representatives and members of the public in North
Lanarkshire was limited to one session during the Partnership for Change Quarterly
Assimilation Meeting in January 2020. The session entailed a brief presentation introducing
the concept of social prescribing followed by a short interactive exercise in which attendees
engaged in small group discussions of two scenarios describing local people experiencing
social, emotional or practical difficulties affecting their health and wellbeing. Participants
easily recognised the potential for non-medical interventions to help improve health and
wellbeing for people and readily identified a range of relevant community-based supports as
well as potential barriers that could prevent individuals from accessing services and activities
in their local community, frequently citing as barriers lack of awareness of what is available
locally, affordability, lack of transport or money for bus fares, lack of confidence, and mobility
problems.
The statutory stakeholders interviewed in this study expressed optimistic views about public
understanding of the value of social interventions in North Lanarkshire, and the likelihood of
this being an enabler for wider acceptance of social prescribing; and public engagement
should not simply be thought about in terms of public education.
“I think the general public are open to [alternatives to medicine and medical prescribing] more than they were before” (Interviewee 5)
“I’ve got quite a strong belief that it’s a societal issue…so we need to move away from trying to fix people who are ill towards trying to help everybody understand more and do more to help their own mental health and physical health as well; physical health is more embedded already, people understand that you need to keep your weight down and keep fit and do these sorts of things but they don’t think actually you need to do things that support your mental health” (Interviewee 3)
“It’s a difficult one isn’t it because ‘how do we educate the public?’ frequently comes up in debate – do we need to educate the public? I think if we’re doing what we should be doing well then it doesn’t need education it just needs us to behave in a way that is helpful to people and change mindsets through building different confidence” (Interviewee 2)
The Partnership for Change Development Lead emphasised the importance of meaningful
public engagement and the necessity to involve people in any service-level change agenda
from the outset, reflecting on the lack of public engagement in the development of the
Primary Care Improvement Plan and subsequent effort involved in changing negative public
perspectives retrospectively.
The Partnership for Change Development Lead also stressed the need for clarity of
language around social prescribing and a common understanding of the terms being used.
“…all these words mean different things and we need to be clear what we’re talking about” (Partnership for Change Development Lead)
84
Draft v0.1
SECTION 5. Challenges and Opportunities
5.1 Strategic fit
From the overview of strategic plans described in section 2.2, strategic intentions in North
Lanarkshire appear to be united in the direction of early intervention, prevention and a more
assets-based, holistic approach to addressing health and care support needs that puts
people and communities at the centre of how services are organised and delivered; with the
recognition that addressing the social determinants of health is critical to improving health
and wellbeing and tackling health inequalities. All of these things resonate strongly with the
core principles of social prescribing. There is also a shared commitment expressed to
collaborative, cross-sectoral partnership working.
The Community Solutions Programme strategy and commissioning plan has a different
timeframe to HSCNL’s current commissioning plan, which makes maintaining strategic
alignment more challenging. The probable need to take time to ensure this strategic
alignment is maintained was noted in the elucidation of statutory stakeholder perspectives
on social prescribing in section 4.4.1. One of the accepted effective principles for social
prescribing is that partners should cooperate at strategic as well as operational levels so
ensuring strategic cross-sectoral alignment ought to be a collective responsibility.
Development of a framework for social prescribing for North Lanarkshire presents an
opportunity to review how each partner can best contribute to achieving shared strategic
goals.
5.2 Creating a coordinated and strategic approachSeveral social prescribing initiatives are already operating in North Lanarkshire including
various link worker roles that are seemingly not aligned or co-ordinated. An opportunity for
development may be to consider how to increase alignment and co-ordination in how social
prescribing is currently organised and delivered in North Lanarkshire. A more aligned and
strategic approach would potentially help to avoid duplication, reduce inefficiencies, mitigate
against thinking about services in silos and ensure that social prescribing initiatives do not
develop in a fragmented way.
5.3 Funding sustainability
The Community Solutions Programme has been established through sustained partnership
working, its governance arrangements are highly regarded, and it is undoubtedly a robust
model to support the delivery of social prescribing across North Lanarkshire. This study
highlights that current funding insecurity threatens to weaken the programme’s ability to build
85
Draft v0.1
and sustain the community provider capacity required for staff and volunteers to feel able to
support social prescribing and securing longer term investment remains a challenge.
A range of high-quality community-based services has to be available locally for social
prescribing initiatives to be sustainable whatever the delivery model and many community-
based organisations cannot be assumed to have the existing capacity and resources to
support more people referred through social prescribing.
Balancing funding for link workers and community-based activities, for example, requires
planning by commissioners, service designers, and the voluntary and community sectors.
Funding models in which funding follows the patient when referrals are made from primary
care may be worth exploring. As might opportunities to diversify funding streams for social
prescribing beyond the health and social care system.
5.4 What social prescribing means
Social prescribing means different things to different people in North Lanarkshire and the
term itself is not familiar to many. Experiential learning from others indicates that social
prescribing works best where all those involved have a common understanding of what it is,
what it can offer and who it can benefit. However social prescribing is to be framed in North
Lanarkshire, the concept and the terminology need to be clear and easily understood by all
stakeholders. Likely stakeholders include commissioners, referrers, delivery partners and
communities.
Health Improvement teams whose expertise is highly regarded by healthcare colleagues in
North Lanarkshire could play an important role as formal and informal educators. The
informal knowledge transfer that is already happening in the course of everyday
collaborative working should be actively encouraged.
Ways might also be found to enable transfer of the wealth of practice-based knowledge of
the concept and practice of social prescribing that exists within the community and voluntary
sector in North Lanarkshire; possibly joint initiatives with Health Improvement teams who are
also well-connected with local communities.
5.5 Raising awareness
Raising awareness of social prescribing may be required and how social prescribing is to be
framed locally will determine who that would be useful for.
There is a recognised need to raise awareness of social prescribing in the statutory sector in
North Lanarkshire. One of the considerations that informants in this study and other
commentators point out is that promoting the concept and benefits of social prescribing to
86
Draft v0.1
health and care professionals only makes sense if the community-based supports are there
to refer to; and to be assured of that requires sustainable funding arrangements to already
be in place.
Lack of knowledge about what community-based supports are available is commonly
identified as a barrier to social prescribing. Raising awareness of what is available may not
however be sufficient in itself for some healthcare practitioners to respond to problems
caused by social difficulties. Active facilitation may be required to help them see the
connection to the social problems they identify and recognise the potential benefits of social
prescribing for themselves and service users. In order encourage the practice of social
prescribing awareness raising for health and other professionals should encompass the
connection to the social model of health, not just what options are available, emphasing how
the medical and social models together furnish holistic care.
5.6 Skills and competencies
There may be a need to educate some healthcare professionals and other referrers on the
different aspects of social prescribing and challenge negative attitudes to the social model of
health and individual responsibility. The planned piloting of the 3-conversations approach to
improve ‘first point of contact’ practice among health professionals could help greatly in
changing these attitudes. A similar approach could be used to equip other referrers with the
skills, behaviours and attitudes to identify people who could benefit from social prescribing.
Embedding the ‘no wrong door’ principle more widely throughout North Lanarkshire
approach to social prescribing is another possible opportunity for development.
Not having the confidence and skills to engage service users in conversations about social
prescribing can be a challenge for staff. It has been said that social prescribing initiatives can
provide a platform through which practitioners can confidently ask people ‘how can I help
you’ and ‘what matters to you’, knowing they have a process in place to help them guide
people towards a range of suitable local supports. Efforts to raise awareness of social
prescribing and give practitioners the confidence to do it are likely to be complementary.
There is plethora of advice on core competencies for link workers based in primary care
settings including ScotPHN’s guidance for HSCPs on induction and core training for the GP
Community Link Workers being engaged under the new GMS contract. As described in
section 4.3.4 there are several other link worker roles operating in North Lanarkshire
managed largely within the community and voluntary sector and variously situated in
healthcare and community and voluntary sector organisations. Developing a framework for
social prescribing for North Lanarkshire may be an opportunity to consider how to facilitate
shared learning among link workers performing similar roles and whether training and
87
Draft v0.1
development opportunities for link workers and the wider provider base could be more
inclusive.
In regard to developing social prescribing for children, young people and families, but with
wider relevance to social prescribing overall in the context of communities being important
delivery partners, it has been suggested that training in social prescribing skills would be
useful for a number of people including health visitors, school nurses, teachers and
education staff, family support workers, local club leaders, faith leaders and any voluntary
sector or statutory agency working with people at risk.86
5.7 Target groups
While social prescribing has the potential to benefit a whole range of people most initiatives
tend to target specific groups such as groups experiencing particular disadvantage or health
conditions, and some proactively seek-out prospective service users such as ‘hard to reach’
groups or ‘high resource use’ individuals. Some sources caution that aiming to
accommodate the general population can be more challenging and could cause confusion
about who is eligible to be referred and discourage buy-in from healthcare professionals.
In deciding how social prescribing is to be framed in North Lanarkshire it may be worthwhile
revisiting the conceptual stepped model previously envisaged for the delivery of social
prescribing in Lanarkshire (section 3.1.4 Figure 3) that incorporated different levels of
support for different groups dependent on need.
As highlighted in this report, social prescribing for children and young people and explicitly
encompassing families has been largely neglected in the design and implementation of
social prescribing initiatives. Given the social, emotional and practical challenges facing
many young people and families in North Lanarkshire who could benefit from social
prescribing, and the range of expertise within the community and voluntary sector,
development of a social prescribing framework for North Lanarkshire offers an ideal
opportunity to ensure they are included. It is not enough to group this population with adults
and the elderly.
Here also is an opportunity to consider equality proofing North Lanarkshire’s approach to
social prescribing to ensure it does not risk widening health inequalities. Local areas can use
existing knowledge to identify target groups, which in North Lanarkshire might include the
locality profiles, existing needs assessments or information gathered through planning
processes. Community and voluntary sector providers have expressed some misgivings
86 Social prescribing. Healthy London Partnership 2017 https://www.healthylondon.org/wp-content/uploads/2017/10/Social-prescribing-Steps-towards-implementing-self-care-January-2017.pdf
88
Draft v0.1
about placing too much reliance on the locality profiles as indicators of local needs and the
risk of thereby promoting a ‘postcode lottery’ for social prescribing and creating a barrier to
inclusion for some community-based organisations. There may, therefore, be value in
exploring ways of incorporating the experiential knowledge of local needs within the
community and voluntary sector in the interpretation of locality data; and in the context of
prevention and early intervention gaining their insight on how some of these problems arise.
5.8 Enabling referral
Referral pathways for social prescribing should be designed to fit the target population. This
includes consideration of referral routes into the service, who can refer and receive referrals,
who is eligible for referral, and referral criteria that should be co-produced with all partners to
ensure clarity and transparency. Referral guidelines may need to be developed.
Developing a framework for social prescribing may be an opportune time to consider
embedding the approach within existing referral pathways.
Incorporating referral from a wide range of local agencies is recommended as being
conducive to coordinating support around the person and encouraging partnership working.
There are potential sources of referral for children and young people especially that might
need to be considered such as school nurses, education staff and family support workers.
Expanding initial access points for social prescribing could also be a way to reach people
who have little or no engagement with statutory services.
Whatever the approach, to encourage uptake the processes for referral to social prescribing
have to be clear and easy to use for all those involved.
Lack of knowledge about what community-based supports are available is a commonly cited
barrier to referral for social prescribing. Implementing the new GP Link Worker role is a clear
opportunity to enhance referral practice in the primary care setting. Knowledge of the
opportunities that are available locally is however vital to successful link working and every
opportunity should be taken to learn from the extensive local knowledge that community and
voluntary sector providers already have.
Electronic directories of local groups and services available to help people with social
problems can help improve referral pathways if they are user-friendly and kept up to date.
North Lanarkshire has Locator, which is maintained by VANL and like similar resources
elsewhere in Scotland (including the national information system ALISS) keeping it up to
date and optimising its utility in relation to content and accessibility is not without its
challenges. As one statutory sector interviewee suggested, developing a framework for
social prescribing presents an opportunity to consider how the utility of Locator and other
89
Draft v0.1
tools including MLE and Well Connected could be optimised collectively to better support
social prescribing in North Lanarkshire. Since the Locality Consortium has the mapping of
local service provision that is to be made available through Locator within its Terms of
Reference the Consortium may be best placed to consider how that particular process might
be improved.
Navigating the boundary between the levels of need that social prescribing can support and
needs that require clinical or other professional intervention can be a challenge and
community-based organisations often encounter barriers to making referrals in to statutory
services. Mechanisms may need to be put in place to enable this to happen.
5.9 Workforce
Staff training, support and engagement can all help to make social prescribing feel part of
everyday health and social care services and not an additional area of work. It can also
ensure that staff have a sense of ownership and a clear understanding of how they can
contribute to social prescribing.87
Specific resources may need to be developed and as already noted should be set in the
context of inequalities and the social model of health. Opportunities for cross-sectoral
workforce development should be considered, taking account of the whole system including
the statutory and community and voluntary sector paid and volunteer workforce.
HSCNL’s Strategic Plan recognises that the health and social care workforce within public,
third sector and independent organisations and those who volunteer in communities are
central to the delivery of better outcomes for people; and as new services are developed
staff will require different skills and will need to work in different ways, in particular the skills
and capacity for early intervention and preventative approaches. An integrated workforce
strategy is being developed to cover NHS and Local Authority staff who work in integrated
service provision. The high proportion of the workforce for social prescribing will be in the
community and voluntary sector, so in considering a framework for social prescribing there is
an important opportunity for HSCNL and VANL as the Third Sector Interface to work
together to agree a joined-up approach to workforce development for all their delivery
partners.
5.10 Public engagementAs already noted, the Partnership for Change Development Lead has emphasised the
importance of meaningful public engagement to involve people in any service-level change
87 Dumfries & Galloway Social Prescribing Regional Framework https://www.parliament.scot/S5_HealthandSportCommittee/General%20Documents/20191111_Claire_Thirwall_-_Dumfries_and_Galloway.pdf
90
Draft v0.1
agenda from the outset, and that this requires forward planning. In developing a framework
for social prescribing, North Lanarkshire has the opportunity to work with Partnership for
Change to consider any requirements around public engagement and how it should be done
in line with the principles set out in HSCNL’s Participation and Engagement Strategy.
It may also be an opportunity to have conversations to learn from what others have found to
work well. Learning from Dumfries and Galloway, for example, an area which has had
particular success around public engagement in developing its framework for a social
prescribing (which like Community Solutions has its origins in the Change Fund era) points
to the value of working through existing locality structures to involve communities in
developing the local ‘brand’, giving communities a sense of ownership and building the
communication strategy around that (Claire Thirwall, Health and Wellbeing Specialist,
Dumfries and Galloway Council, Personal Communication, 20 Feb 2020)88. Further
engagement brought community groups together to help develop referral pathways; and
higher-level engagement work with local area committees and councillors to ensure they
were always included and aware of what was happening in their local communities. The
importance of giving feedback to the community was considered really important, not just
taking people’s information but telling them how it has been used. This kind of considered
approach takes time.
“As a process it was really useful for us as well; again it was about that engagement and embedding, we were continuously drip-feeding the concept of social prescribing into the community” (Claire Thirwall, Health and Wellbeing Specialist, Dumfries and Galloway Council)
5.11 Outcomes, monitoring and evaluation
NHS North Lanarkshire is fortunate in having an Evaluation Manager as a source of
expertise to support monitoring and evaluation for social prescribing, which can be
challenging.
Commissioners need to be clear about the intended outcomes for any service they
commission, and local stakeholders will have different views on the outcomes they expect
social prescribing to deliver locally. So early discussion with all stakeholder groups and
outcomes prioritisation should be the starting point for planning how progress will be
monitored and what outcomes information will be captured. The existing evidence base
should inform decisions about which outcomes expectations are realistic and likely to be
measurable. This approach provides an opportunity to focus monitoring and evaluation
efforts on intended by the primary intended users to ensure that the information collected will
88 Unfortunately this work has not been written-up
91
Draft v0.1
be useful and used. It can also clarify where monitoring will suffice and evaluation is
necessary.
Attention should be paid to the process of implementing social prescribing as well as
outcomes; and to balancing measures to ensure that improvements in one part of the
system are not causing problems in other parts of the system, which is especially relevant to
cross-sectoral initiatives like social prescribing (for example improving referral rates from
primary care overwhelming the capacity of community-based organisations to provide
support).
5.12 Digital connectivity
Linking statutory service user records to information on services people have accessed in
the community in order to track referrals and enable feedback to the referrer is a major
challenge for social prescribing initiatives. Several companies have developed software for
this purpose, which could be explored, and others can develop a bespoke system89, but cost
could be a barrier especially for implementation on a scale larger that an individual project.
Examples include the Elemental Core digital platform being used in the SPRING Social
Prescribing Project in North Lanarkshire (section 4.3.3) to enable the flow of information
between GP practices and link workers situated in a community and voluntary sector
organisation and the collection of information for monitoring and evaluation. This system
being in use locally is an opportunity to glean any transferrable learning that could help
inform how existing local IT systems might at least be improved. Statutory sector
interviewees in this study confirm that getting feedback on the progress of referrals was a
significant motivational factor for staff buy-in to social prescribing so how feedback loops can
otherwise be established between different sectors will need to be discussed.
5.13 Work best undertaken on a pan-Lanarkshire level
Recent work undertaken in South Lanarkshire to develop a framework for social prescribing
offers a timely opportunity to consider any areas of similarity that could be developed jointly,
such as developing and delivering training around social prescribing skills and
competencies, or investment in improving IT systems. And to ensure that the separate area
frameworks will not create barriers or inequalities of access for people living in either area to
community and voluntary sector services that operate across North and South Lanarkshire
(or operational difficulties for those organisations).
89 https://waystowellness.org.uk/shared-learning-consultancy/
92
Draft v0.1
Section 6. Recommendations The greatest concern identified by the scoping study is funding insecurity within the
community and voluntary sector. Community and voluntary sector organisations have a
vital role to play in any social prescribing initiative as the main providers of community-
based services and supports and sustainable funding models have to be in place for
social prescribing to work effectively.
The Community Solutions programme model and governance structures embody core
attributes for an effective delivery model for social prescribing across North Lanarkshire
that is co-produced, locally owned and highly regarded. Maximising its potential should
be a priority.
Consider what social prescribing means for North Lanarkshire and how it will be defined
in order that all those involved have a good understanding of what it is, what it can offer
and who it can benefit.
Learning from the various social prescribing initiatives already operating in North
Lanarkshire about what works, barriers and enablers, should inform future service
provision; and consideration given to increasing alignment and co-ordination in how
social prescribing is currently organised and delivered, which would help to position new
initiatives to best advantage.
Consider how the utility of Locator and other tools including MLE and Well Connected
could be optimised collectively to better support social prescribing in North Lanarkshire.
The planning and delivery of any social prescribing service should take account of the
support needs of the population served. Available data on deprivation and health
inequalities may help to identify target groups particularly in relation to vulnerable
groups, if that approach is being considered, and the range of local supports that would
need to be available; but it is recommended that these data are considered alongside the
practice-based knowledge of community-based organisations in order to gain a fuller
understanding of local needs and gaps in provision.
Consideration should be given to how social prescribing can best be delivered to be
accessible to and serve the needs of children young people and families; and where
awareness raising and training in social prescribing skills may be useful for additional
delivery partners.
Restricting social prescribing to a limited range of support options is not recommend if it
is to be wholly person-centred and give people choice to decide which services or
93
Draft v0.1
activities can improve their personal situation; and risks undermining inclusivity as well
as underutilisation of local assets.
Work with Partnership for Change to consider requirements and planning around
service-user and public engagement; and make use of existing structures to engage with
different groups.
A need exists to raise awareness of the concept of social prescribing more widely within
the statutory sector as does an element of need to change attitudes to its value as well
as whose responsibility it is to take account of the wider determinants of health in the
care they provide: successfully embedding a ‘3 conversations’ approach is likely to be an
important enabler of effective social prescribing practice.
Opportunities for cross-sectoral workforce development should be considered, taking
account of the whole system including the statutory and community and voluntary sector
paid and volunteer workforce. HSCNL and VANL should work together to agree a joined-
up approach to workforce development for all their delivery partners.
Evidencing the benefits of social prescribing is challenging: social prescribing is not a
discrete intervention so it is important to be clear from the outset about what it is that is
being evaluated; outcomes expectations have to be realistic and measurable, and
agreement reached on the level of evidence that is going to be acceptable in relation to
what the information is to be used for.
The perspectives of other key stakeholders not represented in this scoping study may
need to be ascertained.
94
Draft v0.1
References
Bertotti M, Wali Haque H, Lombardo C. A Systematic Map of the UK literature on navigation roles in primary care: social prescribing link workers in context. University of East London 2019. https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=2ahUKEwjX487_3JLpAhVJfMAKHU9yBHkQFjABegQIARAB&url=https%3A%2F%2Fwww.london.gov.uk%2Fsites%2Fdefault%2Ffiles%2Fsys_map_of_navigator_roles_final_sub_bertotti_et_al_uel.pdf&usg=AOvVaw0qmqsRN5gtY5qPndq11fN8
Bickerdike L, Booth A, Wilson PM, Farley K, Wright K. Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open 2017;7:e013384.
Brandling J, House W. Social prescribing in general practice: adding meaning to medicine. British Journal of General Practice 2009:59(563):454-456.
Carrick K, Burton K, Barclay P. Forecast Social Return on Investment analysis on the co-location of advice workers with consensual access to individual medical records in medical practices. Improvement Service and NHS Lothian 2016.
Chatterjee HK, Camic PM, Lockyer B, et al. Non-clinical community interventions: a systematised review of social prescribing schemes. Arts & Health 2018;10(2):97-123.
[CordisBright] What works in social prescribing? CordisBright 2019. https://www.cordisbright.co.uk/admin/resources/08-hsc-evidence-reviews-social-prescribing.pdf
Davison E, Hall A, Anderson Z, et al. Connecting communities and healthcare: Making social prescribing work for everyone. National Lottery Community Fund 2019. https://www.tnlcommunityfund.org.uk/media/social_prescribing_connecting_communities_healthcare.pdf
Dayson C, Bennet E. Evaluation of Doncaster Social Prescribing Service: understanding outcomes and impact. Sheffield Hallam University 2016. https://www4.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/eval-doncaster-social-prescribing-service.pdf
Drinkwater C, Wildman J, Moffatt S. Social Prescribing. BMJ 2019;364:l1285.
Dundee Strategic Social Prescribing Group. Social Prescribing as a spectrum of approaches: mapping activity in Dundee. 2019. https://www.dundeecity.gov.uk/sites/default/files/publications/socialprescribingsurveyreport-april2019.pdf
[Elemental] VCSE Sector Engagement and Social Prescribing. Elemental 2018. https://elementalsoftware.co/vcse-sector-engagement-social-prescribing-report/
[ERS] Newcastle Social Prescribing Project Final Report. ERS 2013. https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiT-86_0OrpAhWWi1wKHfL_BX0QFjABegQIAxAB&url=http%3A%2F%2Fphw.soutron.net%2FLibrary%2FCatalogues%2FControls%2FDownload.aspx%3Fid%3D161&usg=AOvVaw3c77Bi7xMlwP9PUMRmnoIh
[EVOC] Community Activity Mentors: An evaluation from inception to established role. EVOC 2017. https://www.evoc.org.uk/wordpress/wp-content/media/2017/02/Community-Activity-Mentors-Report-%E2%80%93-An-evaluation-from-inception-to-established-role-1.pdf
95
Draft v0.1
[Family Action] Social Prescribing in Secondary Care Pilot Service Evaluation Report. Family Action 2018. https://www.family-action.org.uk/content/uploads/2018/11/Social-Prescribing-in-Secondary-Care-Evaluation-Report-FINAL.pdf
Fancourt D, Finn S. What is the evidence on the role of the arts in improving health and well-being? WHO 2019
Farenden C, Mitchell C, Feast S, et al. Community navigation in Brighton and Hove: evaluation of a social prescribing pilot. Brighton and Hove Impetus 2015 https://ihub.scot/media/1656/cn-full-evaluation-nov-2015.pdf
Gilburt H. Supporting integration through new roles and working across boundaries. The King’s Fund 2016. https://www.kingsfund.org.uk/publications/supporting-integration-new-roles-boundaries
[Health Education England] Social prescribing at a glance North West England. Health Education England 2016. https://www.hee.nhs.uk/sites/default/files/documents/Social%20Prescribing%20at%20a%20glance.pdf
[Health Foundation] Mortality and life expectancy trends in the UK. Health Foundation 2019. https://www.health.org.uk/publications/reports/mortality-and-life-expectancy-trends-in-the-uk
[Health Scotland] Social prescribing for mental health: guidance paper, Health Scotland 2016. http://www.healthscotland.scot/media/2068/social-prescribing-for-mental-health-guidance-paper.pdf
[Healthy London Partnership] Social prescribing for children, young people, parents and carers. Healthy London Partnership 2018. https://wiki.healthylondon.org/Social_prescribing_for_children,_young_people,_parents_and_carers#:~:text=Social%20prescribing%20provides%20a%20means,the%20elderly%20when%20designing%20and
Hayes D, Cortina MA, Labno A, et al. Social prescribing in children and young people A review of the evidence. UCL Evidence Based Practice Unit 2020. https://www.ucl.ac.uk/evidence-based-practice-unit/sites/evidence-based-practice-unit/files/review_social_prescribing_in_children_and_young_people_final_0.pdf
Husk K, Elston J, Gradinger F, et al. Social prescribing: where is the evidence? British Journal of General Practice 2019; 69(678):6-7.
Jani A, Bertotti M, Lazzari A, et al. Investing resources to address social factors affecting health: the essential role of social prescribing. J Royal College Med 2020;113(1):24-27.
Jani A, Harrington R, Gray M. Digitally enabled social prescriptions: adaptive interventions to promote health in children and young people. Journal of the Royal Society of Medicine 2019.
Kimberlee R. What is social prescribing? Advances in Social Sciences Research Journal (2015); 2 (1):102-110.
[King’s Fund] What is social prescribing? The King’s Fund 2017. https://www.kingsfund.org.uk/publications/social-prescribing
Kinsella S. Social Prescribing A review of the evidence. Wirral Borough Council 2015. https://pdfs.semanticscholar.org/a8fc/f89494c10e0d324c7052407f1cbb8c3bacb0.pdf?_ga=2.251862793.1457971945.1591344037-86769826.1585841113
Langford K, Baeck P, Hampson M. More Than Medicine: New Services for People Powered Health. NESTA 2013. https://media.nesta.org.uk/documents/more_than_medicine.pdf
[Liverpool CCG] Strengthening social prescribing in Liverpool: Connecting for health and well-being. Liverpool Clinical Commissioning Group 2017.
Lorenc T, Petticrew M, Welch V, et al. What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health 2013;67:190-193.
96
Draft v0.1
Macintyre S. Inequalities in health in Scotland: What are they and what can we do about them? MRC Social and Public Health Sciences Unit 2007. https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=2ahUKEwifzcy1k4jpAhVUVsAKHclaB_EQFjABegQIARAB&url=http%3A%2F%2Fwww.sphsu.mrc.ac.uk%2Freports%2FOP017.pdf&usg=AOvVaw2P0BDfzFYkZOYtbjvO9f8H
Mason J, Gatineau M, Beynon C, et al. Effectiveness of social prescribing: An evidence synthesis. Public Health England 2019 https://www.scie-socialcareonline.org.uk/effectiveness-of-social-prescribing-an-evidence-synthesis/r/a116f00000Uhql9AABck
Mercer S, Wyke S, Fitzpatrick B, et al. Evaluation of the Glasgow ‘Deep End’ Links Worker Programme. Health Scotland 2017. http://www.healthscotland.com/uploads/documents/29438-1.%20Evaluation%20of%20the%20Glasgow%20'Deep%20End'%20Links%20Worker%20Programme%20-%20May%202017%20-%20English.pdf
Moffatt S, Steer M, Penn L, et al What is the impact of ‘social prescribing’? Perspectives of adults with long-term health conditions. BMJ Open 2017;7:e015203. PubMed 10.1136/bmjopen-2016-015203.
Newton B, Sinclair A, Tyers C, et al. Supporting disadvantaged young people into meaningful work: An initial evidence review to identify what works and inform good practice among practitioners and employers. Institute for Employment Studies 2020. https://www.employment-studies.co.uk/system/files/resources/files/548_0.pdf?utm_source=IES+emailing+list&utm_campaign=9ffde01ecb-EMAIL_CAMPAIGN_2019_05_14_03_45_COPY_04&utm_medium=email&utm_term=0_f11585705b-9ffde01ecb-354273645
[NHS England] Social prescribing and community-based support Summary guide. NHS England 2019 https://www.england.nhs.uk/wp-content/uploads/2019/01/social-prescribing-community-based-support-summary-guide.pdf
Paterson A. Redefining the model: An introduction to social prescribing, Chex 2019. https://mustard-apple-97ns.squarespace.com/our-work/2020/1/1/briefing-social-prescribing-redefining-health-and-social-care
Polley M, Bertotti M, Kimberlee R, Pilkington K, Refsum C. A review of the evidence assessing impact of social prescribing on healthcare demand and cost implications. University of Westminster 2017(a). https://westminsterresearch.westminster.ac.uk/download/e18716e6c96cc93153baa8e757f8feb602fe99539fa281433535f89af85fb550/297582/review-of-evidence-assessing-impact-of-social-prescribing.pdf
Polley M, Fleming J, Anfilogoff T, et al. Making Sense of social prescribing. University of Westminster 2017(b). https://westminsterresearch.westminster.ac.uk/download/f3cf4b949511304f762bdec137844251031072697ae511a462eac9150d6ba8e0/1340196/Making-sense-of-social-prescribing%202017.pdf
Popay J, Kowarzik U, Mallinson S, et al. Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part I: the GP perspective. J Epidemiol Community Health 2007;61:966-971.
97
Draft v0.1
Price S, Hookway A, King S. Social prescribing evidence map: summary report. Public Health Wales Observatory 2017 https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwixw4Sv6pLpAhVTVBUIHf3IAyUQFjAAegQIBhAB&url=http%3A%2F%2Fwww2.nphs.wales.nhs.uk%3A8080%2FPubHObservatoryProjDocs.nsf%2F0%2Fd8aba77d02cf471c80258148002ad093%2F%24FILE%2FSocial%2520prescribing%2520summary%2520report%2520v1%2520GROUPWARE.pdf&usg=AOvVaw1925f93sO9hN2LFJ8pLcZz
[Public Health England] Social prescribing: applying All Our Health. Public Health England 2019. https://www.gov.uk/government/publications/social-prescribing-applying-all-our-health/social-prescribing-applying-all-our-health
[Public Health Wales] Social prescribing in Wales. Public Health Wales 2018. http://www.primarycareone.wales.nhs.uk/sitesplus/documents/1191/Social%20Prescribing%20Final%20Report%20v9%202018.pdf
[RCGP] Spotlight on the 10 High Impact Actions RCGP 2018. http://allcatsrgrey.org.uk/wp/download/primary_care/RCGP-spotlight-on-the-10-high-impact-actions-may-2018_2.pdf
[SenSCOT] Social prescribing: The role of Social Enterprise. SenSCOT 2018. https://senscot.net/wp-content/uploads/2018/03/Social-Prescribing-Briefing-Final.pdf
Skivington K, Smith M, Chng NR, et al. Delivering a primary care-based social prescribing initiative: a qualitative study of the benefits and challenges. British Journal of General Practice 2018;68(672):e487-e494.
Smith M, Skivington K. Community Links: Perspectives of community organisations on the Links Worker Programme pilot and on collaborative working with primary health care. Health Scotland 2016. http://www.healthscotland.scot/media/1253/27362-community-links-evaluation-report-april-2016-cr.pdf
Steadman K, Thomas R, Donnaloja V. Social prescribing: a pathway to work? Work Foundation 2017. Available here: https://www.scie.org.uk/prevention/research-practice/getdetailedresultbyid?id=a11G000000PYsKCIA1
[UCL Laws] Health Justice Partnerships in Social Prescribing International Workshop. UCL Laws 2017. https://www.ucl.ac.uk/access-to-justice/sites/access-to-justice/files/hjp_workshop_updated_information_final.pdf; https://www.ucl.ac.uk/access-to-justice/sites/access-to-justice/files/hjp_workshop_background_materials_and_event_report_2.pdf
[Voluntary Health Scotland] Gold Star exemplars: Third Sector approaches to Community Link Working across Scotland. Voluntary Health Scotland 2017. https://vhscotland.org.uk/wp-content/uploads/2017/06/Gold_Star_Exemplars_Full-Report_June_2017.pdf
[Volunteer Scotland] Volunteering on prescription. Volunteer Scotland 2015. https://www.volunteerscotland.net/media/984713/volunteering_on_prescription_-_final_report.pdf
Wildman JM, Moffatt S, Steer M, et al. Service-users’ perspectives of link worker social prescribing: a qualitative follow-up study. BMC Public Health 2019;19:98.
Year of Care, Thanks for the Petunias–a guide to developing and commissioning non-traditional providers to support the self management of people with long term conditions
98
Draft v0.1
2011. https://www.yearofcare.co.uk/sites/default/files/pdfs/Thanks%20for%20the%20Petunias.pdf
99
Draft v0.1
Appendices
Appendix A. Informants and Acknowledgements
Statutory sector
Interviewees
Alastair Cook, Medical Director, HSCNL
Morag Dendy, Head of Planning, Performance and Quality Assurance, HSCNL
Philip McMenemy, Associate Medical Director, NHS Lanarkshire
Robert Peat, Head of Profession – Podiatry, HSCNL
Sharon Simpson, Organisational Development Lead, NHS Lanarkshire
Raymond Taylor, Health & Social Work Manager, HSCNL
Other informants
Susan McMorrin, Senior Health Promotion Officer (South Lanarkshire), NHS Lanarkshire
Helen Alexander, Evaluation Manager, NHS Lanarkshire
Community and Voluntary Sector
Focus group participants
Carolanne Christie, Information and Engagement Worker, North Lanarkshire Cares Together
Jacqui Flanagan, Project Manager, LANDED Peer Education Service
Frances McKay, Information and Engagement Worker, North Lanarkshire Cares Together
Claire Mooney, Nutritionist, Lanarkshire Community Food & health Partnership
Lynne Morris, Family Support Coordinator, Home Start
Mark Soanes, Operations and Development Manager, Hope for Autism
Other informants
Sarah Burgess, Development Officer (Green Health Volunteering), Voluntary Action South
Lanarkshire
Ayeshah Khan, Director, The Health and Wellness Hub, Motherwell
Fiona McCabe, Project Co-ordinator, Community Action Newarthill
100
Draft v0.1
Thomas Moan, Development Worker, Partnership for Change
Anne Marie Toner, Specialist Case Worker, Routes to Work
David Tough, Community Link Worker, SAMH
Ann-Marie Treacy and team, Bellshill & Mossend YMCA
June Vallance, Executive Manager; Katherine and Becky, Social Prescribers, SPRING
Social Prescribing Project, Getting Better Together Ltd
Lorraine Van Beuge, Project Manager; Bryony and Laura, Community Connectors, North
Lanarkshire Disability Forum
Brenda Vincent, Equals Advocacy
Attendees who shared their views at the following events:
Locality Area Events: Airdrie; Cumbernauld and North; Bellshill; Motherwell; Wishaw and
Shotts; Coatbridge, October-December 2019
North Lanarkshire’s Community and Voluntary Sector Children, Young People and Families
Network meeting November 2019
Partnership for Change Quarterly Assimilation Meeting January 2020
External informants
John Cassidy, Chair, Scottish Communities for Health and Wellbeing
Jane Ford and Ruth Dryden, Public Health Intelligence Advisers (Evaluation), NHS Health
Scotland
Claire Thirwall, Health and Wellbeing Specialist, Dumfries and Galloway Council
101
Draft v0.1
Appendix B. Interview and Focus Group guides
Interview Guide – Social Prescribing – Statutory SectorTo what extent do you think the concept of social prescribing is well understood by statutory sector health and care providers in North Lanarkshire?
- Are people talking about the same thing when they talk about social prescribing- What should we be talking about- Is there more that could be done to raise awareness of what it is, what it can offer and
who it can benefit
Alignment with strategic priorities
- Does consideration of social prescribing approaches come up in strategic or planning level discussions around service delivery; in what context
- Attitudes towards social prescribing approaches in helping to deliver on strategic priorities; views on supporting evidence
- Expectations of what it can achieve
In relation to where we are now and where we’d like to be in North Lanarkshire in terms of embedding the practice of social prescribing in how services are delivered, what’s already being done well and what more needs to be done?
- What should we keep doing and build on- To what extent can this be done within existing structures and resources- Governance to ensure coherence and efficiency- What would success look like - what kind of evidence would be sufficient- What is needed to ensure sustainability
In terms of taking the SP agenda forward, is there one major thing we need to do that would make the biggest difference at this time?
Is there anything else you would like to add?
102
Draft v0.1
Community and voluntary sector focus group guide
Explore the meaning of social prescribing
- Opportunities and barriers
Working in partnership with statutory health and social care services
- Relationships between statutory and community services; organisation and individual level
What needs to be considered in order for social prescribing to work for children and young people
- Community resources available for young people- Partnership working with education and other services- barriers
Understanding local needs and gaps in services
- Social prescribing as a means of addressing health inequalities: usefulness of locality profiles; perception of areas of greatest need/disadvantage; demand and gaps in services
- CVS perception of areas of unmet need in the provision of local services If there was a menu of community-based supports what should be on it?
Capacity and ability to deliver social prescribing/respond to increased demand
- How organisations currently respond to increases in demand; accommodating more people referred through social prescribing
- Could increases referrals through social prescribing compromise delivery for other service users, people accessing your service through other routes, direct
- Appropriateness of referrals; people with complex support needs; mechanisms to refer to statutory services
What is already being done well and what more needs to be done
- What should we keep doing and build on- To what extent can this be done within existing structures and resources- Governance to ensure coherence and efficiency- What is needed to ensure sustainability
Additional support requirements
- Capacity building to deliver social prescribing; skills/training needs- Volunteers
103
Recommended