Social Prescribing

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Equal Arts Carers’ Cultural Adventures’ Group flying their handmade Korean flags Photographer Dani Giddins
Equal Arts Carers’ Cultural Adventures’ Group flying their handmade Korean flags. Photographer Dani Giddins

Social Prescribing: Facts and links

Arts on Prescription Gloucestershire has shown a 37% drop in GP consultation rates and a 27% reduction in hospital admissions. A social return on investment of between £4 and £11 has been calculated for every £1 invested in arts on prescription.

Introduction

This is intended to be an interactive document that changes over time. Although there are well-established and long-running arts-on-prescription and museums-on-prescription schemes around the country, we are still learning about how culture, creativity and social prescribing can work together. If you are aware of gaps in this document, please get in touch and start the discussion. [last update: 5 Feb 2020)

What is social prescribing?

The term is used largely in relation to primary care (general practice). It describes the practice of referring patients to social activities instead of or as complementary to more ‘conventional’ forms of medicine.

You can find out about social prescribing via the Social Prescribing Network. The network also has regional representatives across the country – please contact them if you want to start a discussion about your own work. A new National Academy for Social Prescribing (NASP) was launched by Health and Social Care Secretary Matt Hancock on 23 October 2019. This independent organisation was developed in a cross-government partnership including Sport England and Arts Council England. It is chaired by Profesor Helen Stokes-Lampard (former chair of the Royal College of GPs). You can read about the full board here. NASP will also be an important source of information as it seeks to standardise practice, provide training and increase awareness. (You can watch a video of Hancock from the launch here.)

The free UCL Life Learning course developed by the Culture, Health & Wellbeing Alliance includes a helpful introduction to social prescribing. You can find the course here. (NB The course is called Museums as Spaces for Wellbeing, but it applies equally across the arts and heritage sectors, as well as to libraries and other public and cultural spaces.)

 

Social prescribing, arts-on-prescription, museums-on-prescription, and our members

Arts-on-prescription and museums-on-prescription are types of social prescribing.

Museums on Prescription was an award-winning three-year research project (2014-17) led by Professor Helen Chatterjee and funded by the Arts and Humanities Research Council investigating the value of heritage encounters in social prescribing. Its website contains numerous extremely useful resources including powerpoints and a systematic review of 86 social prescribing schemes.

Four cultural social prescribing initiatives are described here in a press release from the All-Party Parliamentary Group for Arts, Health & Wellbeing: Arts on Prescription Gloucestershire (Artlift), Arts & Minds, START Inspiring Minds and the Community Connector Scheme. The press release also summarises the evidence generated by Arts on Prescription Gloucestershire:

The scheme has shown a 37% drop in GP consultation rates and a 27% reduction in hospital admissions. A social return on investment of between £4 and £11 has been calculated for every £1 invested in arts on prescription.

Results from our spring 2019 annual survey suggest that just under 40% of respondents are working with social prescribing. Activities range from a Local History Café targeting loneliness and social isolation in older people to a choir in a doctor’s surgery. One response spoke of the “need to build arts referral into social support offer”.

 

Support, funding and structures

Government support – and some risks

Social Prescribing is currently being championed by both the Department of Health and NHS England in its Long-Term Plan. The Secretary of State for Health and Social Care, Matt Hancock, spoke about culture and creativity in relation to social prescribing in November 2018 at the King’s Fund. He said

The arts can help keep us well, aid our recovery and support longer lives better lived.

And

And I want to say this very frankly, social prescribing reduces the over subscription of drugs. It can lead to the same or better outcomes for patients without so many pills and it saves money for the NHS because many of these social cures are either free or cheaper.

While many of us have long campaigned for the demedicalisation of care and support the basic aims of social prescribing, there remain concerns about how the community-based 'prescriptions' will be funded. In his own video from the launch of the NASP, Hancock said 'whilst there's billions of pounds spent on the PR and he marketing for drugs, sometimes... the best things in life are free'. In his speech during the evening, however, he has been reported as saying that, as with pharmaceutical products, funding should follow the it will be essential for money to flow in accordance with patient need to the intervention delivered. (No transcript has been made of this speech.)

More organisations are articulating the need to support the delivery organisations actually providing the 'prescriptions': A new report (Feb 2020) from the National Lottery Community Fund, for example, says

It’s essential that the services and activities recommended to patients are also adequately and sustainably funded.

The NHS Long-Term Plan (2018) says that

Within five years over 2.5 million more people will benefit from ‘social prescribing’, a personal health budget, and new support for managing their own health in partnership with patients' groups and the voluntary sector.

You can read a blog by the Chair of the Culture, Health and Wellbeing Alliance, Alex Coulter, about government and social prescribing, and the work of the All-Party Parliamentary Group for Arts, health and Wellbeing here. The blog also has useful examples of good practice. (You can find out more about the APPG here.) There is also blog here by the Director of the Culture, Health & Wellbeing Alliance.

 

Government funding

In August 2018 the government announced funding for 23 pilot schemes across the country, to a total of £4.5m. Some cultural work was included in this phase but to the best of our knowledge this represents a relatively small proportion of the social prescribing activities funded. You can read about the schemes here.

Further funding was announced to support 1,000 link workers (see below) in January 2019. The NHS Long Term Plan says that

Over 1,000 trained social prescribing link workers will be in place by the end of 2020/21 rising further by 2023/24, with the aim that over 900,000 people are able to be referred to social prescribing schemes by then.

It now seems likely that NHS England is aiming to employ roughly 4,500 link workers in the medium term, although as far as we know there has been no official announcement of this larger number.

No funding has yet been announced for ‘providers’ (i.e. organisations or individuals providing the activities). In some areas Clinical Commissioning Groups (CCGs) have provided some funding for work through their own budgets. In other areas organisations have funded this work through arts/cultural funding.

The National Academy for Social Prescribing is being funded to the tune of £5m including some support from Arts Council England.

 

Link workers: "the glue in health and social care"*

Link workers are currently seen as the key to social prescribing. They will work with GPs and Primary Care Networks (PCNs - see below) to direct people visiting the GP into local activities. To understand more about link workers, read Christiana Melam's blog on link workers (Christiana is Chief Executive Officer of National Association of Link Workers, a member of the BME Leadership Network and National Primary Care Network Stakeholder group.) And listen to this podcast from the General Practice Podcast with Marie-Anne Essam.

You can read the link worker job description here, as part of this document from NHS England:

There are many different names used to describe the link worker role. These include wellbeing advisor, community connector, community navigator, community health worker, community health agent, health advisor, depending on local preference. Whilst the names may be different, the core elements of the role remain the same, hence the generic ‘link worker’ term.

NHS England's summary guide for Social Prescribing and Community-Based Support says:

Link workers typically work with people over 6-12 contacts (including phone calls and meetings) over a three-month period (depending on what the person needs) with a typical annual caseload of up to 250 people, depending on the complexity of people’s needs and the maturity of the social prescribing scheme.

Thus far, however, it seems the caseload is likely to be far higher than this. Link workers will also be responsible for assessing what community activities are suitable and available where they work, and will likely be very important contacts for any cultural organisations wanting to connect with social prescribing.

 

Primary Care Networks (PCNs)

PCNs are new networks; they are made up of GP practices and community, mental health, social care, pharmacy, hospital and voluntary services in the local area. They cover populations of 30,000 to 50,000 people. Based on the population of England that means there will be about 1,400 of these networks. In some areas these already exist, in some areas they are just being developed. Read more about PCNs here.

diagram of structures social prescribing sits in

What about ethics and risk?

A Quality Assurance Guide for social prescribing has been developed by Craig Lister (Green Gym) with support from an advisory panel and the University of Westminster – and endorsed by the Royal Society for Public Health. It suggests a three-tier approach that distinguishes between levels of ‘acute risk’ from low to high – but some of the work here does seem to sit with providers rather than commissioners. The  Guide states that

Organisations providing support and activities to people with more complex health needs, especially where there is an acute (current and potentially immediate) risk to health or life, will need to meet a more vigorous quality assurance in terms of particularly health and safety and escalation procedures.

The ideal model is about building relationships and developing community partnerships - risk is mitigated through these relationships. But there may be more work to be done to unpack the question of lines of responsibility.

 

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