Changing lives, changing places, changing systems
Charlotte Augst and James Sanderson
- Person-centred care
- Health inequalities
- Integrated care
One of the consistently heartening things about working together around social prescribing – as we in NHS England and National Voices have now been doing over many years – is the sense that we are working on the same side. Our shared commitment to shifting the NHS to focus on enabling people and communities to live well, alongside treating ill-health, means that we are determined to make the most of the significant investment that NHS England has made in social prescribing link worker roles in primary care.
Because we’ve been working on this for many years, we’re familiar with the journey that social prescribing has been on – from an innovative new way of supporting health and wellbeing pioneered by a few – to a nationally and internationally recognised model, backed with funding and infrastructure. We also understand that, while it may revolve around them from the perspective of the individual, social prescribing is not just about link workers. It relies on a wider “ecosystem” that encompasses groups, activities and services from the most formal to the least, from large to small, from national to hyper-local level across many sectors. So making social prescribing work is a joint responsibility – which will rely on collaboration and vision.
However it was clear, as we embarked on our most recent project, that there was more to do to ensure that the wide range of stakeholders – across different government departments, funding bodies, health leadership, local authorities and the voluntary, community and social enterprise (VCSE) sectors – were willing and able to be part of this work. So we spent time talking to them about what would help them do this – and National Voices latest report, produced in partnership with New Philanthropy Capital – sets out what we found.
The key message is that social prescribing is still not well known or understood. Too often it is thought of as a “niche” service – something for a group of enthusiasts – and there is not enough focus on where social prescribing fits within and contributes to the big picture strategic change we want to see. To move forwards we need to be clear that social prescribing is about:
- Improving health and wellbeing – getting ahead of ill-health and enabling people to live well, rather than running to catch up
- Improving access to health and care services – we know there are issues across the system that leave those who need support most missing out
- Providing more holistic support – getting away from a system that creates a new pathway per body part leaving the person lost at the crossroads, towards one which is about what matters to me, rather than what’s the matter with me
- Reducing inequalities – supporting people most likely to experience health inequalities to tackle wider determinants of health
All of these are real challenges and make up our urgent agenda. Social prescribing is one of the ways we will achieve these goals. But of course it’s not the only driver of these changes. We need to go where the energy is, build on what’s already strong and give people the flexibility to develop structures that work for their local contexts. In some places there are already bespoke structures for social prescribing, but in others we can take forward this work within other collaborations. The key point – as the National Voices report recognises – is that there are structures in every Integrated Care System – for strategy, planning, and crucially funding not just of link worker roles but also the broader ecosystem of support around social prescribing including a range of community-based activities and support.
The establishment of integrated care systems should provide greater opportunities to develop and nurture the cross-sector partnerships that we need to build and sustain the ecosystems that enable social prescribing to thrive. We will need leadership at all levels of integrated care systems to get behind this work, and strategies to develop shared investment models to sustain community activities and support which improves population health and addresses local health inequalities.
We’re in another period of change across the NHS, and for partners in communities. Structural change is never easy, and it comes at a time of intense pressure on everyone – people, communities, and providers. But until we unlock the power of people and communities, and build bridges between health systems and community assets, we won’t be able to shift those pressures. And that’s why we’re determined to keep progressing this agenda. In the meantime we’d love to hear your reflections on the report. Do drop us a line at email@example.com.