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Social prescribing

Social prescribing involves empowering individuals to improve their health and wellbeing and social welfare by connecting them to non-medical and community support services. It is an innovative and growing movement, with the potential to reduce the financial burden on the NHS and particularly on primary care (The Social Prescribing Network).

Social Prescribing and the VCSE sector in Manchester
Nigel Rose, Strategic Lead (Commissioning)

Four years ago, Macc was heavily involved in putting together a bid for money through Greater Manchester Health & Social Care Partnership for a prevention bid. Not all of it was funded but out of it came Health Development Co-ordinators in neighbourhoods, about £1 million in VCSE funding (the 2019 OPeNS funding programme) and social prescribing.

The social prescribing part of the bid was tendered out as Be Well, initially in north and then more recently in central and south Manchester. Be Well in north was originally run by Greater Manchester Mental Health NHS Foundation Trust but following a recent re-tendering, Be Well across the whole of Manchester will now be run by Big Life, a VCSE organisation. Big Life has sub-contracted to a number of other VCSE organisations who bring local knowledge and connections with Manchester’s neighbourhoods.

There are many versions of social prescribing but all have at their core the same idea, that linking people with long-term needs to community assets will help to improve their wellbeing. Health and social care services, though vital, are only part of the solution. It’s about how we live the rest of our lives. The term community assets is used to mean any local services or amenities whether VCSE, statutory or private that might be of help to someone. This could be a gym, knitting club, park or a sports club. Many will be associated with or run by a VCSE organisation.

The model adopted in Manchester has three elements. The first is a one-to-one service where a referral is received, an assessment is made and then the worker provides some support including coaching, sign-posting and possibly more direct support to enable involvement with other community assets. The assessment is a critical part in that it is a holistic assessment that assesses both needs and strengths, and focuses on what the person themselves wants to achieve. The second element is providing advice to other health and social care professionals within a neighbourhood or across Manchester about what community assets are available. The third element is providing information, such as newsletters, for their own staff, for other health and social care staff and to people in the area about what’s available in their neighbourhood. The concentration of work so far has been on the first element.

In the relatively short time that social prescribing has been running in Manchester, there have been many significant successes. Be Well is working with large numbers of people and has developed good working relationships with many GP practices and has been working very much in a strength-based approach. The introduction of social prescribing has also raised some important issues, many of which were predictable and were discussed prior as part of the planning process. However, at that time, there was insufficient evidence and understanding of the issues to address them. This is no longer true.These issues are:

1) Pressure on VCSE organisations - The upshot of the sector being recognised for the critical part they play in wellbeing is that some organisations are now being overwhelmed by referrals. Though some general funding is provided through Manchester City Council for VCSE organisations through the Our Manchester VCSE Grants Programme, and through the associated OPeNS fund, there is still a shortfall. There are organisations who are having to refuse referrals as they have no further capacity. There is rising anger about this and calls for increased funding to the VCSE sector in line with the increased demand.

2) Equality - There are many neighbourhoods who lack significant VCSE support in a number of areas. For example, there may be good support for older people in the area but little or nothing for people with dementia or for carers. There may be lots of organisations but very few that cater appropriately for people from the huge variety of BAME communities in Manchester. For social prescribing to work properly, there needs to be equal access to VCSE support in every neighbourhood.

3) Referrals - When Be Well began it only accepted referrals through GPs. This had some justification to begin with as it can be difficult to ensure that GPs are fully integrated with other health and social care services. However, as social prescribing continues, there are understandable demands from VCSE groups who are accepting referrals to be able to refer directly to social prescribing. They want it to be a two way process.

4) City-wide VCSE - Be Well is not only referring to neighbourhood organisations but it is also referring to city-wide organisations which specialise in mental health, support for LGBTQ communities, for victims of domestic violence or support with benefits. Inevitably, referrals are increasing for these organisations and this needs to be recognised and additional funding found.

5) Mental health crisis - One of the 'unexpected' (not to many of us) issues that Be Well has picked up is the lack of mental health services. They are coming across increasing numbers of people with serious mental health problems that are unable to access services or who have been discharged. This reflects the lack of community support for people with serious mental health problems following discharge. It cannot be up to Be Well to fill this gap and a big question remains about how the invaluable information gathered by Be Well will be used to inform future commissioning and funding.

It is still relatively early days for Be Well and social prescribing in Manchester and it is still very much in the learning stages. There is huge potential for building on the work being done and a great deal still to explore. However, there is only funding for one more year and continuation funding has yet to be agreed.

The adoption of social prescribing recognises the critical part that VCSE organisations play in the health and wellbeing of people in Manchester which is a major step forward. It’s now time to look at our role in social prescribing and the issues it has brought which is why we are calling on the VCSE sector in Manchester to produce a social prescribing manifesto at our next Voluntary Sector Assembly on 30 March. To register your interest in the event and for more details, please visit our website.

If you want to find out more about this work, please contact Nigel at nigel@macc.org.uk.

"One problem is that when you sell the concept to GPs they think there's loads of free stuff"
Social prescribing is not alway a win-win, a April 2018 article from Third Sector, looks at the importance of funding for social prescribing projects and the great results that come from investing in this work. This includes a quote from Macc Chief Executive Mike Wild. 

Primary Care Led Prevention Programme
Manchester City Council, in partnership with a range of organisations including Macc, has developed the 'One Team' Primary Care Led Prevention Programme proposal (attached below) which will be put forward as part of the Transformation Proposal submitted to the Greater Manchester Health and Social Care Partnership. The Prevention Programme proposal takes a community centred, asset based approach to delivering care, and promoting health and wellbeing for residents of the 12 One Team neighbourhoods. The 5 objectives of the programme will be for neighbourhood teams to;

1) Support residents in strengthening the social determinants of health such as employment and skills, finance, housing and social connectedness
2) Support the adoption of healthy lifestyle choices across the life course such as physical activity, nutrition, smoking cessation and emotional wellbeing
3) Improve the quality of life, health outcomes and life expectancy of people with long-term conditions by identifying long-term conditions early (“finding the missing 1000s”), and facilitating a proactive approach to management of long-term conditions
4) Optimise the health of people with long term conditions, both by enhancing standards of clinical care and supporting the mental health and social needs of people with these conditions
5) Use asset-based, personalised and holistic approaches to enable self care.

Social prescribing is an important part of this approach and there is reference in the proposal document to a social prescribing hub - Community Links for Health. It states that:

"A coherent citywide social prescribing model will be developed to give people who access health and care services, a link to social and non-medical support within the community. One clear referral system or single point of access will allow One Team health and care practitioners (starting with GPs) to connect people with various sources of support that address the social determinants of health. Embedding this model will enable the transformation to an asset-based approach to health, and similar approaches that have been tested in the city to be delivered at scale, and a time-limited transformation team to deliver the large scale change required."

Also, this approach will be adopted separately in North Manchester soon as the CCGs have already agreed to adopt the Prevention Programme proposal. The tender for provision of this programme will be released shortly.

King's Fund - What is social prescribing?
A February 2017 article by The King's Fund describes what social prescribing is, and gives an update about the latest evidence about its benefits and how it fits into wider health and care policy. It states that 'There is emerging evidence that social prescribing can lead to a range of positive health and well-being outcomes' but there is limited systematic evidence at the moment.

Rotherham Social Prescribing Service
The Rotherham Social Prescribing Service is a flagship project that has ran since 2012. It helps people with long term health conditions to access a wide variety of services and activities provided by voluntary organisations and community groups in Rotherham. Social prescribing is part of a wider initiative in Rotherham known as case management. Funded by Rotherham Clinical Commissioning Group, the case management scheme brings together health, social care and voluntary sector professionals, who work together in a co-ordinated way to plan care for people with long term health conditions. This joint working is known as integrated case management. GPs lead case management teams and are responsible for identifying patients who are eligible for the scheme.

People can be referred by their GP to the service where they will then be contacted by a Social Prescribing Worker known as a VCS Advisor. The advisor will arrange to visit the person, either in their home or at the GP surgery, to discuss voluntary or community services that could help them to improve health and wellbeing. This is in addition to any NHS or social care support they may already be receiving.

National Social Prescribing Network
The National Social Prescribing Network consists of health professionals, researchers, academics, social prescribing practitioners, representatives from the community and voluntary sector, commissioners and funders, patients and citizens. They are working together to share knowledge and best practice, to support social prescribing at a local and national level and to inform good quality research and evaluation. The network is currently funded by a Wellcome Trust Seed Award (Principal Investigator, Dr Marie Polley) and a donation from Fit for Work UK. It is a collaboration between the University of Westminster and the College of Medicine. NCVO have an involvement and Macc as members are involved in a national programme of infrastructure organisations delivering social prescribing. Learning will be shared as an element of this partnership.

For more information including a list of steering committee members and access to their bulletins, you can visit the National Social Prescribing Network page of the University of Westminster website.