THE ASSET- BASED HEALTH INQUIRY HOW BEST TO DEVELOP SOCIAL PRESCRIBING? It’s to support people with a range of emotional, physical and mental health needs to better access “support, largely in the community, to improve their lives.” Definition of social prescribing, Mick Ward, Leeds City Council The Asset-Based Health Inquiry 3 Report authored by Prof Becky Malby, David Boyle, Janet Wildman, Sandi Smith, Samira Ben Omar, Health Systems Innovation Lab, London South Bank University. September 2019 Foreword Acknowledgements We urgently need to start recognising the real and important social determinants of health, and then address them. Social prescribing aims to do Collaboration is at the heart of this inquiry. As an Inquiry team we have been privileged to meet, talk, precisely that. Approaches to healthcare other than the prescribing of medicines walk and sing with people who truly care about can be incredibly effective. At its best, social prescribing can give people a their local communities, and about the power of purpose in life, a reason for living. It can make people genuinely happy. collaboration between professionals, institutions, people and communities. Social prescribing is therefore incredibly important Everything I saw was admirable. There were We want to thank those that hosted us for visits because of the transformative difference it can make art classes, set up by someone who had been over one day or more, Alvanley Family Practice and to people’s lives, often in situations where a clinical a patient and who had had no optimism their partners in Stockport, Creative Minds (which is approach does not or cannot help. It enables us to about the future but who is now flourishing supported and hosted by the South West Yorkshire reach out to people and help them in a different way. – and all over the walls were displays of art Partnerships NHS Foundation Trust which is part from people who had benefitted from the I saw this for myself as part of the visits we made of the West Yorkshire and Harrogate Health and Trust’s support. They had set up a museum during the inquiry, sites you can read about in this Care Partnership ICS), Frome Medical Practice and of mental health care, which was valuable report. We went to see Alvanley Family Practice, an Health Connections Mendip, The Grenfell community, for reminiscence for people suffering from incredibly impressive GP practice in Stockport. I met community champions and professionals. You were dementia – but also for school children and with patients, and ‘health champions’. They are doing all inspiring. many others. Their approach humanises mental primary care in a radically different way – engaging health care. Seeing them in practice was Thank you to our witnesses for taking the time to with the community, encouraging volunteers to step incredibly impressive. come prepared to the discussions, Allison Trimble – forward – often patients themselves. It provides Senior Leadership Consultant, Kings Fund and early a model for how primary care should operate. At the heart of these examples is the best of founder of collaborative asset based models in the Too frequently, people are treated as passive what social prescribing can do. Not only can UK at Bromley By Bow Centre, Alyson McGregor recipients of healthcare – but not here. I applaud the it empower, it can also transform – both the Chief Executive Altogether Better, Charlotte Augst leadership of all the parties involved in that practice. health and wellbeing of individuals and also CEO National Voices, Christina Melam CEO National whole communities. It enables us to reach I also visited Creative Minds, a charity run by the Association of Link Workers, Mick Ward Chief Officer out and treat people beyond the confines of South West Yorkshire Partnership NHS Mental Health Transformation and Innovation Leeds City Council, clinical medicine. I saw incredible examples of Trust and based in Wakefield. They are working in an Tim Anfilogoff Head of Community Resilience for professionals collaborating with local citizens, enlightened way, engaging with and giving a role Hertfordshire Valleys CCG and Social Prescribing bringing together a wealth of resources. to people who are suffering from mental ill health. Facilitator for NHSE for East of England. Our mental health system too often denies people Social prescribing offers a huge opportunity Thank you to Tony Hufflett from Datasyrup and the agency and dignity. Yet in Wakefield, there was for the way we do primary care. If you trust in London Primary Care Quality Academy for helping real empowerment. People were being treated with people, and their ability to navigate the world with the chapter on measurement. Thank you to Sara dignity and respect — treated as people who have for themselves, the rewards are immense. What Hamilton for getting the Inquiry going. skills and potential. an empowering and liberating vision! We wanted to be sure that in doing this work we held true to the relational approach we are committed too and were investigating in the Inquiry. We therefore really appreciate Sir Norman Lamb, who is hosting the launch of the Inquiry, taking the time to visit sites Sir Norman Lamb, MP with us to fully understand what it takes for social prescribing to be the best it can be. David Boyle, Prof Becky Malby, Janet Wildman, Sandi Smith, Samira Ben Omar Sir Norman Lamb has been the Liberal Democrat MP for North Norfolk since 2001. After serving as a minister in the Department for Business, Innovation and Skills, he was appointed Minister of State for Care and Support at the Department of Health in September 2012 and served in this position until the end of the Coalition Government in May 2015. 4 The Asset-Based Health Inquiry The Asset-Based Health Inquiry 5 Contents Introduction 5 Introduction Phrases like ‘social prescribing’ and ‘coproduction’ speak to missing elements from mainstream healthcare – the need for broader than pharmacological solutions (social 7 Section 1: The Inquiry Findings prescribing) and for sharing the responsibilities for maintaining and recovering health 8 Background (coproduction). Neither of these approaches have yet been able to make the required 10 Solving the problems in general practice impact on mainstream health services. 13 Key issue #A. Purpose: Shifting the burden or meeting complex needs? The social prescribing initiative set out under the NHS Those were our formal objectives. We also wanted 15 Key issue #B. Measurement: Rescuing A&E versus resourcing people? long-term plan that is now being put into practice by to see what the golden thread was in examples 18 Key issue #C. Status: Professionals versus volunteers? NHS England (2019), is in some respects a vindication where ‘social prescribing’ is sticking, by exploring of our approach, developed by the Health Systems issues of power, relationships, informal networks, 21 Key issue #D. Method: Formula versus face-to-face. Innovation Lab at LSBU, where we have studied and collaborative change and the role of policy. 23 Key issue #E. Language: Social prescribers or community connectors? promoted more humane approaches to healthcare, We assert our right to recognise these without working closely with many of the pioneers of social defining them, on the grounds that we know them 24 Key issue #F. Scale: Big versus small prescribing in the UK. when we see them – aware of the assumptions 27 Key issue #G. Costs: Subsidy or homeopathic finance? about what this means in practice. But on closer examination, we were not quite so sure 28 Key issue #Significance: Is this a new model of care? the match was complete. Some of the key people Method 29 Social prescribing: What it takes who have developed the most important social innovations in primary care were nervous about it. This is not a large inquiry. It is a close investigation 32 Conclusions: How it should be done It was not clear whether they were nervous about of a small number of successful examples of 34 Social Prescribing: What it is and what it isn’t: the language of ‘social prescribing’ or about the social prescribing and coproduction in the NHS, organisation of social prescribing, as set out in NHS through visits and witness interviews. We also 35 Recommendations policy. We organised this brief Inquiry in order to attended the 2nd International Social Prescribing 37 Additional resources and references find out, and in particular, to answer the following Network Conference. questions: 38 Appendix 1: The Visits The Inquiry process was framed by a literature review, 1. What does the research literature say about which is provided in Section 2. 51 Section 2: Literature Review social prescribing, particularly about the most An invited inquiry group undertook a learning journey 52 Introduction innovative and exciting versions now working well in the UK? to four sites, which are exemplars of coproduction 53 Structure of the Literature Review or social prescribing approaches to uncover the key 2. What opportunities and challenges are faced by conditions for doing real asset-based collaboration. 54 Social Prescribing Context – What do we know about social prescribing? people in primary care trying to work effectively This was augmented by a number of ‘key witness’ with locals to deliver social prescribing? 62 Social prescribing and theories of change approaches interviews with leaders of the social prescribing 3. Do collaborative or relational methods help? approach, which were transcribed and themed. 71 Tensions and dilemmas to adopting an asset based approach through social prescribing. 4. Where does it work and what helps it work? 77 Leading Change – who are the change agents? And what lessons have been learnt on the way? The Inquiry group made sense of the data collected from the literature review, the learning 80 References 5. What conclusions can we draw about tensions, journeys and interviews.