Enabling Care Closer to Home Through Social Prescribing

By Christiana Melam MBE, Founder- National Association of Link Workers

On September 26th, 2024, I had the honour of speaking at The King’s Fund conference on Enabling Care Closer to Home Through Social Prescribing. As we continue to navigate the complexities of healthcare, it’s critical to shift our focus from hospital-centric models of care to a more community-centered approach, where social prescribing plays a pivotal role.

Why Traditional Healthcare Needs a Shift

For far too long, our healthcare system has been reactive, focusing heavily on crisis interventions and medical treatments. While this model can be effective in emergency situations, it fails to address the underlying social, emotional, and lifestyle factors that greatly influence health. This gap in care has led to what I believe is failure demand—simply put, we are not meeting the real needs of the people who use our services.

Failure demand arises because we continue to focus on treating the symptoms of ill health without addressing the root causes, which are often non-medical determinants such as loneliness, poor diet, physical inactivity, and social inequalities. By turning a blind eye to these critical factors, we have contributed to the growing list of chronic illnesses and conditions, leaving many citizens feeling disempowered, defeated, and disillusioned with the healthcare system.

We need to be proactive, not just reactive. Ignoring these non-medical determinants of health has only compounded the problem, fueling an unsustainable cycle of repeated healthcare crises. The pressure on healthcare is an urgent cry for help, not just from overworked systems, but from communities who need more than just medical interventions to live healthy, fulfilling lives.

The challenge is that traditional healthcare models are often disconnected from community-based support and preventive care. The key to bridging this gap is social prescribing, which provides a structured way to integrate community-based support into the healthcare system. Social prescribing ensures continuity of care by making community resources a part of the treatment plan in a holistic, non-medical way. These services, however, must be appropriately designed, capable of delivering desired outcomes, and risk-assessed in the same way medical treatments are. They should be respected for their role in improving health outcomes, not seen as "fluffy" or an optional extra.

By integrating non-medical interventions into care pathways through social prescribing, we can effectively address a person's social, emotional, and lifestyle needs, which are often the root causes of poor health. This holistic approach is essential for improving overall health and well-being, and social prescribing is the means by which we can make this integration a reality.

The Role of the Community in Health Outcomes

Our communities have a critical role to play in improving health outcomes. During my presentation, I highlighted four examples where community involvement is essential:

1. Self-Management: Many people lack the skills or confidence to manage their own health conditions. This often leads to disease progression, poor health outcomes, and increased healthcare costs. Social prescribing empowers individuals to take control of their health, reducing reliance on acute services and improving long-term outcomes.
2. Physical Activity: Physical inactivity is a global public health issue. It’s a significant contributor to chronic diseases like cardiovascular disease, diabetes, and mental health conditions such as depression and anxiety. By connecting people to community resources that promote physical activity, we can prevent these conditions and reduce the burden on our healthcare system.
3. Loneliness: Loneliness is as harmful to health as smoking and obesity. It increases the risk of heart disease, stroke, and mental health issues such as depression and dementia. Through social prescribing, we can combat loneliness by linking individuals to social activities, fostering connections that improve mental and physical well-being.
4. Diet: Poor diet is a leading cause of chronic diseases, including type 2 diabetes, cardiovascular disease, and obesity. Vulnerable populations, particularly in low-income areas, are most at risk of diet-related ill health. Social prescribing enables us to offer practical support, such as connecting individuals with education or community food programs or cooking classes and working in collaboration with dietitians and clinicians, to promote healthier lifestyles.

National Progress in Social Prescribing: A Foundation for Transformation

Since 2019, NHS England has taken significant steps to embed social prescribing as a core element of healthcare, with substantial progress already being made across several areas. Below are the key developments:

1. National Rollout of Social Prescribing Link Workers (SPLWs): The NHS has funded Social Prescribing Link Workers (SPLWs) across Primary Care Networks (PCNs) since 2019. These link workers are pivotal in providing non-medical interventions to patients, addressing their social, emotional, and practical needs. This ongoing rollout has been a major driver in connecting healthcare with community-based support.
2. NHSE Recovery Plans: Social prescribing has been embedded into various NHS England recovery strategies, including efforts to address primary care challenges, elective care backlogs, and urgent and emergency care needs. Social prescribing provides a solution by shifting some of the burden from hospitals to community-led initiatives.
3. Optimising Personalised Care for Adults: A Framework for Action for Integrated Care Boards (ICBs) and primary care emphasizes optimising personalised care for adults prescribed medicines that can lead to dependence or withdrawal, such as opioids for chronic non-cancer pain and antidepressants. The framework encourages offering alternatives to medication, such as social prescribing, wherever appropriate. This is a crucial step toward reducing unnecessary reliance on pharmaceuticals.
4. Occupational Health: The Working Better initiative links health and work by integrating social prescribing into occupational health services. This is a forward-thinking approach that recognizes the importance of addressing health-related work issues through holistic, non-medical interventions.
5. Major Conditions Strategy: The Major Conditions Strategy sets out the case for change and establishes a strategic framework for addressing both primary and secondary prevention of chronic conditions. Social prescribing is highlighted as a key intervention for tackling major health conditions, including chronic pain and cancer, by offering preventive care that goes beyond the traditional healthcare model.
6. NHS Long Term Workforce Plan: The NHS Long Term Workforce Plan demonstrates the critical role social prescribing plays in the future of healthcare. The plan commits to recruiting up to 9,000 Social Prescribing Link Workers, highlighting the importance of scaling up this workforce to meet increasing demand for personalised, preventative community-based care.

Preventing Unnecessary Hospital Admissions

In some regions, SPLWs are working closely with hospital discharge teams and community-based services to identify individuals who can benefit from social prescribing before their conditions worsen. By taking this proactive approach, we can help reduce the strain on acute services, improve patient outcomes, and enhance the overall patient experience. There are no quick fixes, but if we don't start now, then we stand no chance of breaking the cycle. As the government has said, the NHS must reform or die, so we don't really have a choice.

Social prescribing also allows us to target specific populations, such as unpaid carers, high-intensity healthcare users, and individuals dealing with chronic pain or major conditions like cancer. By listening to what matters most to patients and addressing barriers to self-management, we can help them live healthier, more fulfilling lives.

Maximizing Resource Efficiency

To ensure that social prescribing delivers on its promise, we must be strategic in how we design and implement these services and utilise expertise. This requires the NHS to work closely with public health, as social prescribing is delivering on public health priorities that are also NHS priorities. Evidence-based service design is crucial, as is data-driven decision-making. We need to integrate, for example, the PRSB social prescribing information standard into the entire patient journey, making it a seamless part of healthcare delivery.

Integrated Care Systems (ICSs) should aim for one SPLW per 10,000 residents, though this may need to be adjusted based on local needs and complexities. It’s also essential that we support both SPLWs and the Voluntary, Community, and Social Enterprise (VCSE) sector with funding and development opportunities.

Conclusion: Building on the Foundations of Progress

The strides made in social prescribing at a national level represent a major transformation in how healthcare is delivered in England. A strong foundation has been laid, but there is still much work to be done. We must continue to build on this progress by scaling up social prescribing services, integrating them more deeply into healthcare pathways, and ensuring that they are accessible to all who need them. Only then can we truly enable care closer to home.