Social Prescribing Strategy

Governing Body meeting C 6 April 2017

Author(s) Joe Fowler, Programme Director for Neighbourhood Delivery and Mental Health Transformation Sponsor Nicki Doherty, Interim Director – Care Outside of Hospital Is your report for Approval / Consideration / Noting

Consideration and Approval

Are there any Resource Implications (including Financial, Staffing etc)?

Yes

Audit Requirement

CCG Objectives

Which of the CCG’s objectives does this paper support? This paper relates to a number of objectives but in particular provides assurance against the following:

1. To improve patient experience and access to care

2. 2. To improve the quality and equality of healthcare in

4. To ensure there is a sustainable, affordable healthcare system in Sheffield.

Risks: 1.2 System wide or specific provider capacity problems in secondary and/or primary care emerge to prevent delivery of NHS Constitution and/or NHSE required pledges including seven day access

2.4 Insufficient resources across health and social care to be able to prioritise and implement the key developments required to achieve our goal of giving every child and young person the best start in life, potentially increasing demand for health and care services.

The current challenge the health and wellbeing system faces is to adapt and become more sustainable for the 21st Century, enabling people to adapt, change and self-manage in the face of growing social, physical and psychological challenges. Social prescribing is one approach that will enable the health and wellbeing community across the CCG to bring services together around patient need to meet some of these challenges.

1

Equality impact assessment

Have you carried out an Equality Impact Assessment and is it attached? No

PPE Activity

How does your paper support involving patients, carers and the public? As alternative and complimentary means of support to vulnerable communities, patients and carers.

Recommendations

The Governing Body is asked to:  Agree the social prescribing model advocated in this paper  Agree the plan for making social prescribing a more impactful and integral part of the health system and seek an update on the implementation of the plan in July 2017.  Commit to the commercial strategy – i.e. the routing of any funding for community based wellbeing activities through the formally established Community Partnerships.  Commit to the financial strategy for social prescribing – i.e. the allocation of the earmarked social prescribing (CSW) budgets so that we secure the infrastructure for 2017/18.  Recognise social prescribing as a priority for investment of any new / invest to save funding for 2017/18.

2

SSooccial PPrrescscribinngg 1 Introodduction / BaBacckgrouound

1.1 This paper seeks Governing Body commitment to social prescribbing and a plan and investment strategy for making social prescribing a more integral and impactful part of our health and care system.

1.2 The paper defines social prescribing in the Sheffield context; provides a suummmary ofo where we are with social prescribing; sets out the issues we need to sort to achieve improved outcomomes fromom social prescribing in Sheffield; and, sets out a plan for moving forward so that we can deliver improved outcomes at pace.

1.3 The recoommmendations in this paper would mean earmarked CCCCG funding for social prescribing being fully commmmitted for 2017/18. It wwoould also mean that the CCGCG wowould fund the majority of the current cost of Commmmunity Support WoWorkers for 2017/18. This would be on the basis of the CoCouncil increasing funding for the commmmunity activities and support that Community Support Worker (and other similar roles) link people to in their commmmunities.

1.4 A full review of social prescribing has been hit by significant delays resulting from information governance issues. However, the review will be ready in July, which will enable its conclusions to inform CCG commmmissioning intentions and budget setting for 2018/19. 2 What is Social Prescrcribing?

2.1 Social prescribing is often defined in relatively medical terms, e.g.

“Social Prescribing is a way of linking patients in primary care with sources of support within the commumunity. It provides GPs with a non-medical referral option that can operate alongside existing treatments to improve health and well-being.” York University 2015

2.2 Before critiquing this definition, it is wwoorth remeemmbering that the vast majority of people in Sheffield do something every day to improve their health and wellbeing. People wwaalk to wowork and gather their thoughts; sit down for a meal with family and friends; go to a ‘weight watchers’ or dance class; access financial advice; stop for a few seconds to take notice of something beautiful or interesting; pursue a hobby or

1 interest; learn something new; see some live music; help someone to achieve something they couldn’t have done alone; and, so on (and on).

2.3 People in family, social and other networks (e.g. workplace) also support each other. Offering encouragement and information on exercise, giving up smoking, healthy relationships and so on.

2.4 The point being made here is that most people are “social prescribing” for themselves and others already; identifying things and doing things that they need to do to stay healthy and well, and helping others to do the same.

2.5 However, some people, some of the time, need a bit of extra support. For example, they might face a range of challenges that have got on top of them and have support needs that exceed the capabilities of their family or social networks. Examples might include people who have:

o experienced a recent bereavement or relationship breakdown, which has led to them withdrawing from social networks and becoming depressed and isolated; o had a deterioration in their physical or mental health that is affecting their ability to do the things they used to do to stay well; o just moved into a community where they have no support network – perhaps being unaware that there are things going on in the community that would be right up their street (literally and figuratively); or, o be struggling to find the time or the money to do things they used to do because they are spending more time looking after a partner or loved one.

2.6 Without support, the health and wellbeing of some people in situations like these deteriorates and they increasingly depend on public services – e.g. by turning up at the GP frequently, falling behind on their rent, struggling to get the kids to school, being referred for a social care assessment, or, being admitted to hospital with medical issues resulting from self-neglect or an unchecked health issue.

2.7 The challenge for Sheffield is (a) how the city effectively supports more people to connect with and do things that reduce Figure 1 - Wider definition of social prescribing their risk of ill health and improve overall wellbeing; and, (b) how we make sure that this translates into reduced demand for formal public services (so that we better live within our means and protect / prioritise public resources). A logic model for

2 social prescribing benefits is provided at Annex A.

2.8 Th is i s a cha l leng e for the cit y – no t just for G Ps and ot her me d ical pr ofe s si on als. HeHe n c e, a rec en t p resenta tio n at a S hapi ng Sh effiel d ev ent wide n ed the cla ssic de fini tio n of so cial pres cri bing as sh own i n Fi g ure 1.

2.9 WhW hil s t th is defi niti o n of so cia l pre s cr ibing is wid er tha n has bee n use d b y t he NHSHS – th e basi i c mo de l re mai ns t he sa me. This is su mmm ma ris ed briefl y b elow in Fig ure 2 an d e xp and ed t o i nclu de a ntici pa te d ben efi ts a t Anne x A.

2.10 Th is mmo o del is bas e d on w ork d one b y national bodies (e.g. UCL) and locally by VAS an d h ea lth and ca re stak eh o lder s .

Figur e 2 - S ocial P resc ribing Model

•Pe o ple at risk of decli n ing heal t h and wellb e ing are id entifi ed (e.g. . low co nfide n ce / r esil ience, with well b ein g risk facto rs), •Re q uires info an d a dvice to s upp port self ‐ide n tifica tio n (an d sel f ‐ref erral / lin kin g whe re pos sib le); consi ste n t risk ass ess ment a t serv ice touch p oin ts; an d, d ata an alysis to ide ntif y targ et IDE NTNT I FY coh orts

•Pe o ple id entifi ed a s bein g at riss k ar e ref erre d fo r a co nvers a tion w ith a s killed ' link work e r' •Re f erral i s rid icu lou sly qu ick and easy ‐ w ith a ra nge o f refe rral rou tes to suit th e nee ds a nd RE F ER prefer en c es of ref err ers

•Pe o ple re fer red ha ve o ne or mo re con ve rsat ion s wit h a skill ed link work er wh o takes the time to u nder s tan d thei r co ntext and goals (nb pe rso n‐cen tre d ca re) •Co n versa tion (s) co uld be at a lo cal advic e ce ntre, in so meo n e's ho me, or in a se rvi ce set t ing •Pe o ple ar e li nked to su pp ort ann d se rv ices th at c ou ld h elp them to achei ve thei r go als and LIN K red uce th eir risk of po or o ut com es •Lin k wor k ers su pp ort peo ple to 'cros s th e th res hold' a nd acce s s th at sup po rt (i f requ ired )

•Pe o ple ac ces s s upp ort that h elp s th em redu ce the ir risk o f d ecl inin g hea lth an d well b ein g •Pe o ple re ly less on pu blic se rvic es ‐ redu cin g dem and and rele a sin g capa city •Co mmm mun ity a ctivit ies, sup po rt, and servi ces are incre a sin gly tun ed to the need s of peop l e at risk of p oor he alth BENEN EFI T •In vest me nt m oves fro m tre a tm ent se rvices t o p reven tion ‐ sup poo rting m ore lo cal activi t ies

3 3 Are we benefiting from social prescribing in Sheffield?

3.1 The ‘social prescribing’ model is alive and well across much of Sheffield. It is not necessarily described as ‘social prescribing’, but there is plenty of it going on.

3.2 Initiatives that use the social prescribing model include Community Support Workers, Age UK outreach work, MCDT Advocates, SOAR social prescribing, GURU, Floating Support (lower-level short-term engagements), Health Trainers / Champions, and the Council’s Community Reablement Services.

3.3 Over the last year, we know that at least 7,000 people were identified and referred for a ‘linking’ conversation1. And, we know that these conversations led to people doing things that are known to have a significant benefit on their wellbeing.

3.4 Data collected from thousands of social prescriptions in Sheffield shows that for every 100 people referred, there is the following resultant activity:

o 86 of the people will get information and advice on a range of issues from managing debts to local activities o 24 are supported to claim benefits like attendance allowance and carers allowance that they didn’t know they were eligible for o 28 are supported to access local voluntary / community activities o 14 get medium-term support to help them manage a tenancy or avoid eviction (e.g. from Shelter, Age UK, SYHA) o 12 are helped with transport issues o 6 are connected to specific medical services o 6 are linked to equipment retailers / providers o 5 are referred for a formal social care assessment o 6 refuse help

3.5 We have literally hundreds of case studies showing the positive impact of these activities on the lives of individuals in Sheffield2, and lots of positive feedback from health and care staff about the benefits of having social prescribing in place.

3.6 Whilst issues with information governance have thus far hindered the completion of the service evaluation of whether social prescribing has conclusively reduced demand on the health and care system, we can demonstrate clearly that referrers are proving adept at identifying people who are at risk of declining health and wellbeing. And, link workers are proving highly effective at improving peoples’ capabilities to support themselves.

1 This is just data from Community Support Workers, which is routinely collated and analysed. 2 A booklet of case studies is available from [email protected] on request

4 3.7 This is evident in the number of successful claims for benefits like attendance allowance and carers allowance that link workers are helping people to claim for the first time. These benefits are known to help people remmaain independent as they are typically used to pay for cleaners, personal care, transport to apppointments, heating, housing repairs, and so on.

3.8 The immppact of the expansion of the social prescribing infrastructuure in 2015 can be clearly seen in the increased take-up of a range of these type of benefits in Sheffield. Figure 3 below showows this clearly for Carers Allowawance and Figure 4 for Attendance Allowance.

Figure 3 - Carers Allowance Claims (as % of population))

5 Figure 4 - Attendance Allowance Lower Rate Claims (% of 65+ Population) 8.0%

7.0%

6.0% £0.7m

5.0% Sheffield Lower 4.0% Comparator Lower 3.0% Low Rate Top Claimer 2.0%

1.0%

0.0% May 13 May 14 May 15 May 16

3.9 A typical link worker will support people to access around £150,000 of benefits per year3 - although one of our Community Support Workers (who has a welfare background) is on track to support people to claim £310,000 in 2016/17. On average a referral to a link worker costs around £100 but has a direct financial benefit to people at risk of poor health and wellbeing (and the local economy) of around £500 (assuming claims last on average one year).

3.10 Social prescribing is available city-wide. However, referrals are focused in neighbourhoods where health inequalities are most pronounced because this is where the most people identified as being at rksk live. Analysis of 6,000 referrals (mostly over 65s) shows clearly that referrals are heavily weighted towards areas with high health deprivation scores. This analysis is based on referral and deprivation data for areas of around 1,500 people (LSOAs).

Referals per 1,000 Population by IMD Health Decile 100 90 80 70 60 50 Referals per 1,000 O65 Pop. 40 Referals per 1,000 Adult Pop. 30 20 10 0 12 3 4 5 6 7 8 9 10

3 Based on claims lasting one year – many are longer

6 4 What is stopping uuss achieving mmoore?

4.1 Th er e a re a nu mb er of kn own issues with Sheffield’s current implementation of the so cia l p rescr i bing mod el.

4.2 Th er e a re som e a reas of t he ci ty an d so me se rvi ces w he re so c ial pr es cri bing is ba rel y u sed mea n ing th at wh eth er a pe rso n h as the o ptio n or c hoic e of no n- meme di c al sup por t to red uc e thei r ris k of decli ni n g he alt h a nd well b eing dep e nds o n whwh er e th ey liv e an d w hic h GP o r oth er pu bl ic s er vice s the y are i n co nta ct w ith.

4.3 Th is v ar iabili ty in idde ntific ati o n and r eferr al of p eopl e w ho wo uld ben e fit fro m soci a l pr es c rib ing is a pa rtic ular conc er n in are as whwh ere we knowow that ther e are s igni fic a nt l evel s of hea l th de priv atio n. AnAnn ex E pro v ides mor e det ail on areea s of c onn cern.

Note: CSWs only part of the picture – some practices with low CSW referrals have other s ocial px rou tes

4.4 There are different approaches to social prescribing across the city and even within the sammee neighbourhoods. This means that identification of people who wowould benefit from social prescribing is not always consistent; referral routes are unclear to potential referrers (meaning they are less likely to be used); and, some roles can overlap if they are not managed well locally.

4.5 NoNot every area or social prescribing scheme systemamatically mmaanages referrals; records the outcoommes from linking conversations; or, provides accessible feedback to the referrer. The lack of consolidated data also means that commmmissioners do not have the evidence they need to secure continued or increased investment. The lack of feedback also reduces the likkelihood of people continuing to refer.

4.6 Social prescribing is not integrated in to the wider social care access mmoodel (mainly due to the risk of link workers / CSWs becoming overloaded with social

7 care casework). This means that people with existing social care support are not benefiting routinely from social prescribing.

4.7 There is a lack of activities and support in some communities – so there is sometimes a shortage of things for link workers to connect people to. As the use of social prescribing increases, the city will need to increase the availability of community activities and local support services. Some of these activities will be no or low-cost, but we need to avoid assuming that voluntary sector services are cooked up in a magic porridge pot – they cost money and increased use of social prescribing will need to be accompanied by some investment in things to refer to.

4.8 We also need community development activity to focus on the things that communities and people need to maintain / improve their wellbeing, which will require us, in turn, to get smarter at analysing the intelligence gathered from conversations with people at risk of declining health and wellbeing.

4.9 A high impact social prescribing infrastructure is not ‘free’ – there are infrastructure costs, and the link workers that connect people to activities generally need to be paid, well-trained and managed, able to access and be trusted by health and care, and supported with phones, technology, and transport.

4.10 There are currently only just enough known link workers to deal with known demand. However, if social prescribing takes off, as is the intention, then we will need more link workers and this will require investment. A typical link worker will deal with around 8 new referrals per working week (circa 350 per year) – a cost of around £100 per referral. 5 What is the plan for addressing these issues?

5.1 There is a strong consensus about what needs to happen to make social prescribing a more impactful and integral part of public service in Sheffield.

5.2 People at key touch points need to be trained to recognise and refer people at risk of declining health and wellbeing who would benefit from being linked to activities and support services. Wider data from housing and other services also needs to be systematically reviewed to identify people at risk who are not presenting at service touch points.

5.3 We need neighbourhood and city-wide referral points that facilitate very quick and easy referral – this means creating well sign-posted, consolidated referral hubs in neighbourhoods, and a ‘back-up’ central hub for people who do not know the referral arrangements in the neighbourhood.

8 Neighbourhood 1 Referral Hub

Local GP Neighbourhood Neighbourhood X... Referral 2 Referral Hub Hub Hospital Staff?

Local Nurse

Neighbourhood Neighbourhood 7 Referral Hub City 3 Referral Hub Local Housing Referral Officer Hub

Carer?

Neighbourhood Neighbourhood 6 Referral Hub 4 Referral Hub

Neighbourhood Neighbourhood 5 Referral Hub 5 Referral Hub

5.4 Learning from existing good practice in Sheffield would suggest that each referral hub needs to have processes in place to make sure referrals are met with a proportionate, effective and efficient response, which could range from a safeguarding alert (high risk), to an outreach visit from a link worker (med risk), to a referral to published self-help info or an advice café (low risk).

5.5 This ‘triage’ process needs to ‘hide the wiring’ from the referrer and the person referred, and facilitate the effective use of resources in the neighbourhood. This means, for example, matching the right worker to the individual depending on their presenting issues.

5.6 The referral, triage and referral outcome / intelligence data needs to be recorded securely and consistently, so that data can be used to:

o inform city-wide commissioning (including external funding bids) o influence the development of local community assets so that they are tuned to the needs of people at risk; and, o ensure good quality feedback to referrers.

5.7 This strong consensus view has been translated into a ‘maturity index’ for a high- impact social prescribing approach, which is provided at Annex C. This index has been used to assess the readiness of neighbourhoods to implement a high-impact social prescribing approach, which has in turn informed the plan outlined later in this paper.

5.8 Alongside this assessment of readiness, we need to model demand for social prescribing and analyse referrals so that we can estimate the required investment

9 over the next 2 – 3 years in social prescribing infrastructure (central / neighbourhood), link workers, and community activities and support services. This modelling needs to factor in planned developments including:

o The impact of increased primary care use of social prescribing as more GPs are made aware of referral routes and simple one-stop shop referral hubs are put in place in each neighbourhood (could add 2,000 – 3,000 referrals in the next two years) o The impact of re-routing hundreds of referrals per year from GPs to social care. We know that around 4 out of 5 referrals from primary care to social care are subsequently assessed as requiring no further social care action. This is likely to add 1,000 referrals (in addition to the referrals above) o It is expected that thousands of social care referrals from the Council’s contact centres and new locality teams will be re-routed to social prescribing – likely to add around 2,000 referrals o Social prescribing is likely to become the default primary and social care response to people presenting or being assessed as having low-level mental health and care needs – adding around 1,000 referrals o There could be a step change in referrals for mental wellbeing if initiatives to reduce the prescription of anti-depressants involve referrals to social prescribing. This change could add thousands of referrals during 2018/19, and, critically, would change the social prescribing cohort considerably (e.g. lots more working age / working residents)4

5.9 This assessment of future demand, the resources required to meet it, and an assessment of the city and neighbourhood readiness to implement a high impact approach to social prescribing (summary at Annex E), are informing the development of an action plan for the next two years (summary at Annex G). 6 Financial Strategy

Prioritisation and Focus

6.1 Funding to support social prescribing at the neighbourhood level will be allocated in line with the priorities for development in each neighbourhood and the level of need in each neighbourhood.

6.2 For example, it is clear that and Broomhall (amongst others) have high levels of need (high health deprivation) but are not currently able to deliver the high impact social prescribing model because there is a lack of routine identification of need (low referral rates) and no infrastructure to run a functional neighbourhood

4 Note that the evidence base for social prescribing appears to be stronger for mental health and wellbeing

10 referrals hub. We are therefore proposing that these neighbourhoods are prioritised for investment in referral management infrastructure and link workers, and that we do focused work with primary care (in its widest sense) to increase identification and referral rates.

6.3 Funding for the development of community assets (things to link people to) will also be based on assessed need. For example, the allocation of the £400k funding for community-based dementia activities will be based on an assessment of existing activities, dementia prevalence, and levels of health deprivation in the area.

6.4 Prioritisation inevitably means inequitable distribution of funding. This will be mitigated in part by making sure that developments in one area can be used to help other areas make more rapid progress.

Commercial Approach

6.5 Where there are formally established and recognised Community Partnerships – these will be the default investment route for implementing the social prescribing action plan. Investment in social prescribing is already being made in many neighbourhoods via this route and there are framework contracts and monitoring arrangements in place with each partnership.

6.6 Our intention is to increasingly use the framework contracts to support community support services and activities – and encourage collaboration between voluntary and charitable organisations so that less of our precious community resources are spent on competitive tenders and individual grant funding bids. We also intend to allocate funding on a 3-year basis wherever possible to give some sustainability to services. The Community Partnership locations and members are listed at Annex D.

6.7 The Social Prescribing model and the Community Partnerships contracts also offer significant potential to help the city leverage external funding – e.g. applying for funding for community activities to support people to be more physically active. There are also new potential funding streams coming on stream – e.g. there are already strong rumours about new primary care funding for social prescribing and a growing expectation that STPs will invest in social prescribing.

6.8 In the handful of areas with no formally established Community Partnerships in place, work will be done with local groups to support their development – with ad hoc arrangements used to fund activity where necessary. It is highly likely that in some areas of the city that the Council will need to continue to provide a local hub function.

11 2017/18 Funding

6.9 The city’s investment in social prescribing can be split across the components of the model, funding organisation, and by direct and indirect investment as shown in the table below.

Part of Model DIRECT 2017/18 INDIRECT 2017/18 Social  £300k from SCC for Community £m mainstream staff Partnerships to develop neighbourhood Prescribing Infrastructure resources across referral hubs and support systems etc Investment in identifying  £70k from CCG to create central hub public sector – people at risk and for referrals identifying people at managing referral / triage  £862k support for localities (paid direct risk who would benefit process and data to GPs as part of locally commissioned from referral and services money) £1,232k support Community Link Workers  £178k from SCC for Community Range of frontline Support Workers People that have staff providing advice  £493k from CCG for Community conversations with people Support Workers – but not taking social that have been referred  £60k for Age UK Workers (funded by prescribing referrals and link them to support / CCG) specifically activities  £? VCF Workers taking social px referrals £1,258  £327k Health Trainers (SCC)  £200k Health Trainers (CCG)

Community Support and  £492k Public Health Funded Range of other Community Wellbeing Activities Activities publicly / charitably  £110k SCC Health Champions (develop Local activities and support and deliver activities) funded activities - e.g. that people are commonly  £40k SCC MH Social Cafes (new parks, walking groups, linked to recurrent funding for 2017/18) library activities £2,251k  £400k SCC dementia support in communities (new recurrent funding for (not inc Ageing Better) 2017/18)  £80k carer support activities (new recurrent funding for 2017/18)  £189k SCC lunch clubs (funding protected 2017/18)  £875k SCC Community Based Advice (Sheffield Advice)  £65k SCC Innovation Fund (new funding for 2017/18  £1m Ageing Better - Lottery Funding in target areas

6.10 The key funding issues relating to the table above are set out below:

12 6.11 The Council has invested additional funding (£585k) in community based activities for 2017/18 through the retendering and reshaping of contracts. For example, the Council has reduced funding for central building based services and, next year, will be investing more in community-based activities that link workers can support people to access.

6.12 However, the Council has not been able to replace non-recurrent national funding for Council-funded, primary care-based link workers (Community Support Workers) who currently play the key ‘linking role’ for primary care in many areas of the city. This is because the funding released from changes to services has had to be redirected to fund activities in the community.

6.13 Note that there is a natural split emerging in the investment. The CCG are predominantly funding (a) the primary care infrastructure to identify people at risk, and (b) the primary-care based link workers that people at risk are referred to. Whereas the Council investment is increasingly weighted towards (a) development of VCF infrastructure to support social prescribing; and, (b) community activities and support services that people can be linked to. This may provide a useful delineation in the future.

6.14 The costs of maintaining the current cohort of Community Support Workers (without filling several vacancies) is estimated at £758k for 2017/18. The budget secured5 for 2017/18 – subject to Governing Body agreement – is £741k (£563k from CCG, £178k from the Council). The CCG funding includes £70k for the central referral hub, which is generally staffed by a Community Support Worker. Given the likelihood of staff turnover, we have reasonable confidence that the current budget will cover the current cohort of Community Support workers.

6.15 Given the likely increase in the use of social prescribing in 2017/18, it is recommended that we protect the social prescribing infrastructure we have built.

6.16 In practice this means:

o extending the contracts of the current cohort of Community Support Workers for one year (to avoid losing any more talented, well-trained, and locally-connected staff) o protecting the new Council investment in community based activities o looking to secure external funding to support the social prescribing model at a city and neighbourhood level (including from STP where stakeholders identified social prescribing as a top priority)

5 Half of the CCG funding is dependent on agreement to this plan

13 o bringing together stakeholders involved in initiatives related to or dependent on neighbourhood social prescribing approaches (as discussed above) to ensure we understand dependencies and planning timelines

Investment required in the future

6.17 Based on the anticipated developments discussed in paragraph 5.8, referrals could potentially double during 2017/18 to around 1,750 per month – with further increases likely during 2018/19.

6.18 To manage this level of demand, would require us to have (a) around 25 more link workers (circa £750k including costs); (b) robust shared systems in place to manage referrals and management information; and, (c) a significant expansion in community activities and city / neighbourhood support services that people can be linked to.

6.19 Clearly this modelling is crude – but it illustrates that planned initiatives will quickly over-load our social prescribing infrastructure. Given this, we need a strategy for dealing with increased demand.

6.20 There are three main options for dealing with the cost of increases in demand.

6.21 Firstly, we could set aside a reserve each year (around £500k in 2017/18) to fund an expansion of our social prescribing infrastructure as measured demand increases throughout the year. This option is strongly favoured. However, organisational budgets are already committed for 2017/18 so this option is only really feasible if new recurrent funding can be found.

6.22 Secondly, we could require any new initiative or service that is going to refer into the social prescribing infrastructure to fund the cost of expected referrals. For example, if Community Mental Health Teams were looking to make 1,000 referrals, then SHSC would need to commit £100,000 to cover the costs (£100 per referral). This option has some obvious difficulties – not least that the costs associated with services currently using our social prescribing infrastructure (mainly primary care) are met centrally by CCG / SCC.

6.23 A middle ground option could be to secure invest to save funding to sustain the social prescribing infrastructure for the next 1 – 2 years, before moving to a recharge model in 2018/19 with organisations and services committing a level of budget in proportion to their reliance on / benefits achieved from the social prescribing infrastructure.

6.24 Given the above, it is recommended that we (a) track referral rates carefully so we can identify areas of growth and put in place mitigating strategies (e.g. seeking

14 funding); (b) put social prescribing at the front of the queue for new funding / invest to save initiatives – to create a reserve to cope with increase demand; and (c) seek advance contributions from any organisation or service looking to place demand on the social prescribing infrastructure.

6.25 It is recommended that Governing Body ask Council and CCG officers to work on funding models and report back alongside the results of the review in July 2017 in time to inform commissioning intentions for 2018/19. 7 Recommendations

7.1 CCG Governing Body is asked to:

7.2 Agree the social prescribing model set out in this paper

7.3 Protect the social prescribing infrastructure we have built.

7.4 Commit to the financial strategy for social prescribing – i.e. the allocation of the earmarked social prescribing budgets for 12 months so that we can secure the existing infrastructure for 2017/18.

7.5 Agree the plan for making social prescribing a more impactful and integral part of the health system and seek an update in July 2017 on: (a) the implementation of the plan; (b) the proposed future funding model for social prescribing; and, (c) the evaluation of CSWs / social prescribing.

7.6 Commit to the commercial strategy – i.e. the routing of any funding for community based wellbeing activities through established Community Partnerships where they exist.

7.7 Commit to focusing social prescribing investment in areas of greatest need and on the development required to support neighbourhoods to achieve a high impact social prescribing infrastructure.

7.8 Recognise social prescribing as a priority for investment of any new / invest to save funding for 2017/18.

15

Annex A– Social prescrib i ng model and potential ben efits

benefits / grant claim s

Support ed employm e nt / trainin g me ntor

debt a dvice local histor y pee r support

S o, a lot o f thing s have to ha ppen to ens ure individu al healt h and wellb eing benefit s across the identifi ed coho rt are ac tually achie ved ! Howe ver, som e o f the syste m be nefit s are ‘ea sier ’ to achiev e – e.g. evid enc e is p rett y solid t hat refe rrals reduc e use of p rimary care (pa rticular l y fo r menta l health ), and le ad to in crea sed contri buti o n to local econ o my (ben efit s ta ke‐up etc). And, we are reason a bly confide nt from PKW eva luation abo ut redu ced dem and o n so cial care – ( a) d elaying a ccess; a nd, (b) reducin g use of form al paid ‐ for care (lin k to benefi t s ta ke‐u p perha ps). Howev er, redu ced u se o f seco ndar y care wo u ld a ppe ar to rel y on lon g‐term ben efits of im prove d wellb eing (ver y hard to attrib u te) and prim ary care ca pac ity rele a sed by soci a l px being 16 d edicate d to new de mand re ductio n act ivity – e.g. s uppo rting the acut ely u nwell to stay at hom e (v irtu al ward s etc ). Annex B – Community Support Worker Referrals (2016)

17 Annex C - Social Prescribing – Draft Maturity Index

Infrastructure and Access Intelligence and Feedback Knowledge and Skills  It is hard to find a frontline health / care / voluntary  There is granular data and info about every referral,  People dealing with social px referrals are sector worker in our neighbourhood who doesn’t know presenting issues, and outcomes. This is linked to recognised as highly knowledgeable about the how to refer to social px and / or handle a referral peoples medical / care records and fed back offer in the community and what city‐wide themselves proactively to referrers and funders. services can offer to supplement this.  Social px is the default neighbourhood response to  Referrals are triaged to make sure the right person  People dealing with referrals are trained and lower‐level social issues and health risk – and is also with the right skills has a conversation with the person supported to coach people to set and achieve routinely used to make sure people with high needs can referred their wellbeing goals access social support to supplement care / support  The data is routinely analysed to identify gaps in local  Other frontline workers are trained and are  Each neighbourhood (and / or practice) has a single services and activities, and to assess impact now performing this role too referral hub for social prescribing and it takes less than  Community assets and services are developed a minute to make a referral – and less than 24 hours to specifically to meet the needs identified during make contact hundreds of social px conversations. 5. Embedded and Successful 5. Embedded  Referral numbers in the neighbourhood are running at around 5% of the population per annum.

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3

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 Some GPs in some practices know how to engage with  Systems are put in place to record, track and report on  There are a few people in the community that social prescribing. referrals but they are not well used and the data is not are knowledgeable about local assets and  People in the neighbourhood / practices recognise the great. activities but it is ‘pot luck’ whether the person need to rationalise social px‐like referral routes and  Referrers get occasional feedback that their referral is handling a referral has the local knowledge to initiatives – it’s a bit of a spaghetti junction. being dealt with and they occasionally find out what help someone improve their outcomes.  Recorded referrals from the few practices using social has happened.  Some people having ‘social prescribing’ type px are around 100 per annum per practice.  There is anecdotal evidence about community needs conversations are not well‐trained or

1. Starting Out 1. Starting Out from social px conversations but it is not yet informing supported enough so they are actually the development of assets and services in the increasing demand on health, care and other community, which are still commissioned centrally. support services.

18 Annex D – Community Partnerships (locations and member organisations revised 18 Jan 2017

People Keeping Well (PKW) Framework Partnerships

Area 1: , , Rural, Bradfield, , , – (South Housing Association)  Oughtibridge Surgery  Valley Medical Centre  Medical Centre  Stocksbridge Health Forum  Stocksbridge Community Care Group  STEP Development Trust  4SLC  Stocksbridge Community Forum  Woodthorpe Development Trust  Dransfield Properties Limited

Main Contact: Claire Matthews - [email protected] - 0114 2900 218 – Housing Association, 43-47 Wellington Street, Sheffield, S1 4HF

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19 revised 18 Jan 2017

Area 2: Chapel Green, , Burncross, Chapeltown – (SOAR)  Age UK  PACES  Sheffield Citizen’s !dvice  Development Trust  Chapelgreen Practice  St Saviour’s Church  Sheffield Carers’ Centre  Ecclesfield Parish Council  Sheffield 50+  !lzheimer’s Society

Main Contact: Ian Drayton - [email protected] - 0114 213 4066 – or Guy Weston - [email protected] - 0114 213 4065 - SOAR Works, 14 Knutton Road, Sheffield, S5 9NU

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Area 3: Middlewood, , , Bank, , Woodland – (ZEST)  Age UK Sheffield  Burton Street Foundation  Dykes Hall Medical Centre  Places for People Leisure  St John’s Church

Main Contact: Isobel Thomas - [email protected] - 0114 270 2041 - Zest, 18 Upperthorpe, Sheffield, S6 3NA

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Area 4: Fox Hill, New Parson Cross, Old Parson Cross, Southey Green, Longley, Shirecliffe, Colley – (SOAR)  The Healthcare Surgery  Foxhill Forum  LEAF  Parson Cross Initiative (PXI)  Parson Cross Forum  Shirecliffe Forum  Southey Development Forum  Friends of Ecclesfield Library  Sheffield North Live at Home

Main Contact: Ian Drayton - [email protected] - 0114 213 4066 – or Guy Weston - [email protected] - 0114 213 4065 - SOAR Works, 14 Knutton Road, Sheffield, S5 9NU

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20 revised 18 Jan 2017

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Area 5: Shiregreen, Wincobank, Brightside, Flower, Stubbin, Brushes, – (SOAR)  Shiregreen Medical Centre  Concord Sports Centre (SIV)  Firth Park Active (Centre for Life)  Flower Estate Family Action  Flower Estate TARA  St Mary’s Timebuilders  Friends of Wincobank Hill  PACA  Sanctuary Housing  Brushes TARA

Main Contact: Ian Drayton - [email protected] - 0114 213 4066 – or Guy Weston - [email protected] - 0114 213 4065 - SOAR Works, 14 Knutton Road, Sheffield, S5 9NU ______

Area 6: Upperthorpe, Netherthorpe, Walkley, Langsett, Crookesmoor – (ZEST)  Upperthorpe Medical Centre  Age UK  The Vine

Main Contact: Isobel Thomas - [email protected] - 0114 270 2041 - Zest, 18 Upperthorpe, Sheffield, S6 3NA ______

Area 7: , Abbeyfield, Firvale, Firshill, Spital Hill, Woodside and Darnall – (Creative Pathways)  Aspiring Communities Together (ACT)  PACA

Main Contact: Freda Cotterell - [email protected] - 0114 2701066 - Creative Pathways, Offices 1 – 5, Spartan House, 20 Carlisle Street, Sheffield, S4 7LJ ______

Area 8: Firvale, Abbeyfield, Firshill, Burngreave, Woodside – (SOAR)  Page Hall Medical Practice  PACA  MAAN  Aspiring Communities Together (ACT)  Arches Housing  Burngreave TARA  SAGE Greenfingers  SACHMA

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21 revised 18 Jan 2017

Main Contact: Ian Drayton - [email protected] - 0114 213 4066 – or Guy Weston - [email protected] - 0114 213 4065 - SOAR Works, 14 Knutton Road, Sheffield, S5 9NU ______

Area 9: Darnall, Tinsley, Acres Hill (some partnership work with other Clover Group Practices - Jordanthorpe, Mulberry etc.) – (Darnall Wellbeing)

 The Family Development Project  Darnall Forum  Tinsley Forum  Darnall Dementia Group  City Farm – South Yorkshire Energy Centre  Sheffield Carers’ Centre  The Clover Group Practice (Darnall and Tinsley)  York Road Surgery

Main Contact: Lucy Melleney - [email protected] or Natalie Shaw - [email protected] - 0114 249 6315 - Darnall Wellbeing, Darnall Primary Care Centre, 290 Main Road, Darnall, Sheffield, S9 4QH

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Area 10: Broomhill, , – (Heeley Development Trust)  Road Surgery  Crookes Practice  Crosspool Forum  Crookes Forum  Recovery Enterprise  Wesley Hall Lunch Club  St Timothy’s Lunch Club  Crosspool Lunch Club  Crookes TARA  Westminster TARA  St Columba’s Church  The Beacon St Stephen Hill Methodist Church  Tapton Hill Congregational Church  St Francis Roman Catholic Church  Care in Crosspool

Main Contact: Andy Jackson - [email protected] - 0114 2500613 - or Maxine Bowler - [email protected] - 0114 2500 613 - Heeley Development Trust, Ash Tree Yard, 62-68 Thirlwell Road, Sheffield, S8 9TF

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22 revised 18 Jan 2017

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Area 11: City Centre, Broomhall, – (ShipShape)  Ignite Imaginations  Broomhall Centre  Together Women  Devonshire Green Medical Centre  Porterbrook Medical Centre  SIV  Ben’s Centre  U-Night  MAAN

Main Contact: Tanya Basharat - [email protected] - 0114 2500222 - Shipshape Health and Wellbeing Centre, Sharrow Lane, Sheffield, S11 8AE

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Area 12: Manor, Wybourn, Park Hill, Granville – (Manor & Castle Development Trust One)  Dovercourt Surgery  Whitehouse GP Practice  Manor Park Medical Centre  S2 Foodbank  Green Estate  Manor Park Post Office  Manor Assembly  Victoria Centre (Victoria Community Enterprises)  MASKK

Main Contact: Lucy Andrews - [email protected] - 07957 465523 - Manor & Castle Development Trust, The Quadrant, 99 Parkway Avenue, Sheffield, S9 4WG

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Area 13: Highfield, Heeley, , (parts of ) – (Heeley Development Trust)  Sloan Medical Practice  Shipshape  Roshni  FURD Page 5 of 9

23 revised 18 Jan 2017

 Heeley Asian Women’s Group

Main Contact: Andy Jackson - [email protected] - 0114 2500613 - or Maxine Bowler - [email protected] - 0114 2500 613 - Heeley Development Trust, Ash Tree Yard, 62-68 Thirlwell Road, Sheffield, S8 9TF

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Area 14: Gleadless Valley, Gleadless, Heeley (and older people in Hemsworth, Meersbrook, , Highfield – (Heeley City Farm)

 Reach South Sheffield  Heeley Green Surgery  St Wilfrid’s Centre  Church of Nazarene  Sheffield Mind  Heeley Rise TARA  Shelter  Freedom Therapies  Gleadless Medical Centre  Waggon and Horses Community

Main Contact: Shelly McDonald - [email protected] - 0114 3039981 ext 2 - Heeley City Farm, Richards Road, Sheffield, S2 3DT

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Area 15: Gleadless, Arbourthorne, Norfolk Park – (Manor & Castle Development Trust)  East Bank Medical Centre  The Arbourthorne Centre  Norfolk Park Medical Centre  Arbourthorne TARA  Nolfolk Park TARA  Tiddlywinks  Arbourthorne Antics and Arbourthorne Strong & Steady  The Spires Centre  S2 Food Bank

Main Contact: Lucy Andrews - [email protected] - 07957 465523 - Manor & Castle Development Trust, The Quadrant, 99 Parkway Avenue, Sheffield, S9 4WG

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24 revised 18 Jan 2017

Area 16: Gleadless Valley, Gleadless, Heeley (and older people in Hemsworth, Meersbrook, Arbourthorne, Highfield) – (Heeley City Farm)

 Reach South Sheffield  Heeley Green Surgery  St Wilfrid’s Centre  Church of Nazarene  Sheffield Mind  Heeley Rise TARA  Shelter  Freedom Therapies  Gleadless Medical Centre  Waggon and Horses Community Pub

Main Contact: Shelly McDonald - [email protected] - 0114 3039981 ext 2 - Heeley City Farm, Richards Road, Sheffield, S2 3DT

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Area 17: Dore and – (Age UK)  Royal Voluntary Service  Sheffield Citizen’s !dvice  Totley Community Resource & Information Centre  Totley Pharmacy  Sheffield 50+  Sheffield Carers’ Centre  Voluntary Action Sheffield  !lzheimer’s Society  Sheffield Health & Social Care

Main Contact: Andy Callard – [email protected] – 0114 250 2850 – Age UK Sheffield, 44 Castle Square, Sheffield, S1 2GF

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Area 18: Batemoor, Jordanthorpe, Lowedges, Bradway, Greenhill, Beauchief – (Reach South Sheffield)  The Terminus  Shelter  VAS

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25 revised 18 Jan 2017

 CAB  Jordanthorpe Library  Heeley City Farm

Main Contact: Steve Rundell - [email protected] - 07939 411221 - Reach South Sheffield, 187 Blackstock Road, Sheffield, S14 1FX

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Area 19: Woodhouse, , , Westfield – (Woodhouse and District Community Forum)  Westfield Big Local  St !nne’s Community Services  Housing and Neighbourhoods  Woodhouse Health Centre  Sheffield DACT (Drugs and Alcohol / Domestic Abuse Co-ordination Team)  South Yorkshire Police  Woodhouse West Primary School  The Salvation Army Westfield  Activity Sheffield  Breast Cancer Care volunteer  East MAST (Multi-Agency Support Team)  Hackenthorpe Medical Centre  Owlthorpe Surgery  Crystal Peals Medical Centre  !lzheimer’s Society  Workers’ Education !ssociation

Main Contact: Kathryn Taylor – [email protected] – 0114 2690222 – 2 Goathland Place, Woodhouse, Sheffield, S13 7TE

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Area 20: Beighton, Waterthorpe, Sothall, – (ShipShape)  Mosborough Health Centre  Sothall & Beighton Medical Practice  Woodhouse and District Community Forum  Heeley Development Trust  Dawn Young – Independent Training Consultant

Main Contact: Tanya Basharat - [email protected] - 0114 2500222 - Shipshape Health and Wellbeing Centre, Sharrow Lane, Sheffield, S11 8AE

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27 Annex E – Initial Assessment of Maturity of Local Area Social Prescribing Models

Central : Hills, Broomhil, Sharrow vale, City Knowledge and Skills 5 North: , Stocks, Ecclesfield 4.5 North East: Southey, Firth Park, Shiregreen, 4 Burngreave 3.5 East: Darnall, Manor, Richmond, Park and Arbourthorne 3 South: Netheredge and Sharrow, Gleadless Valley, 2.5 , 2 South West: Fulwood, Crookes, , 1.5 South East: Woodhouse, Beighton, Mosborough, 1 0.5 Infrastructure and 0 Community Assets Access

Intelligence and Feedback

28 Annex F – Social Px Referral Rates by Neighbourhood vs Health IMD (CSWs only) REFERRAL RATE (adjusted for population) IMD Health Rank Top 25% 25 ‐ 50 50 ‐ 75 Bottom 25% 1 Fulwood 2 Ecclesall 3 4 Endcliffe 5 Bents Green 5 / Abbeydale 7 Worrall 8 Dore 9 Lodge Moor 10 Greystones 11 Bradway 12 Crosspool 13 14 Sothall 15 Halfway 16 Grenoside 17 Mosborough 18 Broomhill 19 Oughtibridge 20 Beauchief 21 Stannington 21 Crookes 23 Owlthorpe 23 Burncross 25 Norton 26 Greenhill 27 Totley 28 Chapeltown 29 Deepcar 30 Brincliffe 31 Loxley 32 Wharncliffe Side 33 34 Woodseats 35 Middlewood 36 Walkley Bank 37 Wadsley 38 Hillsborough 38 Charnock 40 Meersbrook 41 Gleadless 42 High Green 43 Handsworth 44 Birley 45 Wisewood 45 Beighton 47 Base Green 48 Waterthorpe 49 Highfield 49 Tinsley 51 Fox Hill 51 Housteads 53 Granville 54 Stocksbridge 54 Walkley 54 Westfield 57 Hollins End 58 Langsett 59 Ecclesfield 60 Woodland View 61 Hackenthorpe 61 Heeley 63 Wincobank 63 Sharrow 65 Richmond 66 Woodhouse 66 City Centre 68 Colley 68 Firth Park 68 Hemsworth 71 Crookesmoor 72 Woodthorpe 72 Abbeyfield 74 Fir Vale 75 Acres Hill 76 Southey Green 77 Firshill 78 Shiregreen 79 Lowedges 80 Gleadless Valley 81 New Parson Cross 81 Brightside 81 Netherthorpe 84 Shirecliffe 85 Broomhall 86 Wybourn 87 Park Hill 88 Old Parson Cross 88 Upperthorpe 90 Longley 90 Darnall 92 Norfolk Park 93 Stubbin / Brushes 93 Woodside 95 Arbourthorne 96 Burngreave 97 Batemoor / Jordanthorpe 98 Flower 99 Manor

MCDT Social PX Area SOAR Social PX Area

29 Annex G – Social Prescribing Outline Plan

Project Plan ‐Social Prescribing

Number Milestone/Task Planned Start Planned Finish Actual Finish RAG

M1 Clear and transparent governance in place M1a SCC Governance process agreed 01/03/2017 31st March A M1b CCG Governance process agreed 01/03/2017 31st March A

M2 Project plan is agreed and signed off M2a Agreed by SCC 17/03/2017 31st March A M2b Agreed by CCG 17/03/2017 31st March A

M3 Central Referral Hub in place and live G M3a IT system in place 01/03/2017 03/03/2017 03/03/2017 G M3b Referral form designed 01/03/2017 03/03/2017 03/03/2017 G M3c Icon/link on GP desktop 01/03/2017 03/03/2017 03/03/2017 G M3d Staff in place to manage referrrals 01/03/2017 03/03/2017 03/03/2017 G M3e CP's aware of process 06/03/2017 16/03/2017 G M3f GP's aware of process 09/03/2017 31/03/2017 G M3g CSW's aware of process 05/03/2017 05/03/2017 05/03/2017 G

M4 Maturity Index analysis complete M4a Initial city level desktop analysis 24/02/2017 03/03/2017 03/03/2017 G M4b Practice level analysis 21/02/2017 03/03/2017 10/03/2017 G M4c Community Partnership/VCF sector analysis 03/03/2017 10/03/2017 10/03/2017 G M4d Neighbourhood "Spider Diagram" produced 03/03/2017 10/02/2017 14/03/2017 G M4e Citywide "Current State" identified 03/03/2017 10/03/2017 14/03/2017 G

M5 Citywide Delivery Plan complete 24/02/2017 21/04/2017

Draft complete 24/02/2017 17/03/2017

Consult on draft with stakeholders 20/03/2017 14/04/2017

Amend draft in light of consultation 14/04/2017 21/04/2017

M6 Risks, Issues and Challenges Log in place 03/03/2017 10/03/2017 14/03/2017 G M6a Feed into AS&R 06/03/2017 16/03/2017 G

SP Model reflects and encompasses needs of M7 CYPF M7a Id key stakeholders M7b Preliminary discussion with key stakeholders Workshop with CYPF stakeholders to align M7c protocols etc

M8 Communications Plan in place 14/03/2017 28/04/2017 M8a Carryout a Stakeholder Analysis 14/03/2017 14/04/2017

M9 Resources for life of plan in place 14/03/2017 07/04/2017 A M9a Identify existing resources 03/03/2017 10/03/2017 14/03/2017 G

M9b Identify resources required 03/03/2017 10/03/2017 14/03/2017 G 30 M9c Commissioning Route agreed 17/03/2017 31/03/2017

Social Prescribing Task and Finish group M10 established 14/03/2017 10/04/2017 M10a First meeting and TOR produced 14/04/2017 28/04/2017

Neighbourhood Delivery Plans co‐produced and M11 agreed 21/04/2017 16/06/2017 Draft outline plan produced for each M11a neighbourhood Neighbourhood workshops to develop into M11b delivery plan

Data Management System in place

Assess current systems in place

Asses alternative systems

Options appraisal

Recommendation in year one evaluation report

Year one evaluation complete 30/04/2017 31/03/2018

Data collection methodology in place 16/03/2017 01/04/2017

Montly Data collection from SP Hubs

Montly Data collection from SP Hubs

M All GP practices are making good use of SP SP Model Connected to other referral systems Residents know how to access their local SP hub Social Workers making appropriate use of SP Housing+ officers connected to SP Hubs MAST teams connected to SP hubs

Community Partnerships supported by VAS Community groups supported by

A single Risk Modelling Tool is in place and being used

31