Starting Where The Person Is

Where did it all start for me? The social prescribing journey started with Age UK Oxfordshire’s Community Information Network, getting on for 10 years ago. Back then, it wasn't called social prescribing, but the fundamental activity was finding out what matters to people and working to put them in contact with things that might work for them. And social prescribing is exactly that, isn't it? Back in those early days of CIN, we were looking at how we could reach people when they most needed us. We used to get a lot more of people saying ‘If only I'd known about this when...’ So we were thinking, where are people in contact at times of need? That might be a GP, the hospital, a social worker, the church, Citizens Advice. People come into contact with various bits of the system, which are not usually designed to do what we were doing, which is find out what matters to people in a holistic way. We identified GPs as being a good potential source, people approach GPs with a lot of issues. And so when social prescribing came along, that felt like the answer because this was not us saying ‘If you refer people to us, we can be helpful,’ this was the NHS saying, ‘Actually, we recognise there's some stuff that might be better done by someone else.’ So social prescribing felt like it was meant for us, really, that was always my feeling about it.  

We were approached initially to do a pilot in South Oxfordshire. This was very 'test and learn', let's work together to find out what we can achieve using this. Does it help GPs? Do we see good outcomes for patients? And then when the NHS put some more funding into social prescribing, more PCNs approached us and asked would we be willing to work with them on it. That felt very positive, being commissioned by seven different PCNs. You can be locally quite responsive, meeting their priorities. But in terms of us organising a service, it makes it more challenging. Social prescribing is very fragmented. We had seven different contracts, that just takes quite a lot of management. We don't have an integrated approach as a county. From my perspective, there’s some frustration there. But I continue to be hugely excited by the individual outcomes of social prescribing. I think the possibilities are enormous. We're reaching people we probably wouldn't reach in any other way. I think we have a great team, who are really good at putting people at the centre. There's a lot of jargon around at the moment, co-production or co-design of services. And that's exactly what this is, it's working with an individual, co-designing aspects of their life that are important to them. It isn't us with our menu going in and just check-listing people, it's starting where the person is, and that approach excites me. I think it's exactly what we should be doing.  

I'm always trying to think about how we reach more people. We know that for many people in later life, as they begin to have health problems, there can be a gradual going downhill, just this slight withdrawal from the world, not engaging, being less able to self-care, maybe maintaining independence, but not living the life they'd like to live. That whole thing of the walls closing in – we have people who are living in one or two rooms and not going beyond that. There might be no medical intervention needed, but we know that things are not right for an individual, and is there something that this kind of community intervention, the social prescribing, and also now virtual wards, can bring into somebody's life? That potentially means we have a way of helping people who may have come to us later, they might have been admitted to hospital, but if we can be in contact with those people early, we may be able to prevent some of their decline. That decline might feel inevitable, when actually, it's not. It's about finding that little space where people have gone down a notch or two, but all is not lost – they could just slowly go down further, unless somebody comes in and helps to turn things back round again. 

From our perspective, as an organisation, it feels like it's been quite a journey. You’re on a journey with an individual, and we've been on a bit of a journey with community link activity, but we're getting to a good place. It feels as though there is a much wider recognition of this linking activity than there has been before. The advent of NHS-defined social prescribing made me feel that we were closer to achieving something we set out to achieve at the beginning, opening up the community linking activity to many more people. Having spent days and nights thinking ‘How on earth do we reach people?’, it's made me feel quite happy, because it's something we identified a need for, and we couldn't quite crack it ourselves. We couldn't make those links with GPs work as well as social prescribing has made them work. So it's felt very satisfying, this is something that has enabled us to share our skills and our particular approach with a lot more people. So I'm almost universally positive about it, with those few frustrations of the logistics. 

Just going back to the caveats, though, I think the funding model needs looking at. It's quite a frustrating model – we're not funded to manage it, we're funded for a link worker, but all of that additional input from us is, we can't cost that in. And trying to understand the way the NHS funding system works, there's a lot of complexity in there that we have to grapple with. One pot which was specifically for ring-fenced for social prescribing has stopped, and there is more flexibility for PCNs to use the funding how they feel is most appropriate. I applaud that kind of local control, it's important that practices can make their own decisions based on the needs of their population. But it can be quite difficult to demonstrate the impact of social prescribing. Fundamentally social prescribing is a preventive activity, and it's quite difficult to demonstrate if you've prevented stuff. What you will see, on an almost daily basis, is that for individuals, the outcomes are quite significant and very positive. But demonstrating that can be much harder to do. So we don't altogether have the impact data to compete in that arena. But there's a huge amount going on at the moment, including the storytelling initiative, which gives me a degree of optimism that the approach we’ve developed will continue to be available to people. In some areas, they're calling it social prescribing, in others, it’s virtual wards. But it's the same activity, whatever they call it, that same approach of starting with what matters to the person, listening and finding out what's important for them. 

If I go right back to when I first came into Age Concern, as it then was, twenty-some years ago, I had two ambitions. One of them was to reach more people living in rural areas. In those days, we didn't have any outreach services. Lots and lots of people were missing out, particularly people who lived in rural areas. The other goal was being better at listening to people's voices and making sure that we put people at the centre of what we do, rather than having an off-the-shelf solution. Really being led by them, not us doing the leading. And those two things that I started off with sort of come together in social prescribing. So, when I leave in the autumn, I shall feel a sense of things having been rounded off. As far as you ever round anything off. There will be lots and lots of development, growth, change, but nonetheless, I came into the organisation wanting to do two things, and both things have moved forward, which feels very satisfying. 

What I shall miss is the contact with people who are on the receiving end of social prescribing, because that's what we're all in it for. But we have an utterly stunning team who will take things in directions I couldn't even imagine. My advice for my replacement would be about the importance of seeing the whole system picture. Seeing it from the perspective of social care, from the perspective of GPs, from the perspective of the NHS more widely – be alert to all of those perspectives, but keep the person always at the centre and in your sights. Listen to older people. They know what they need, they know what they want for their lives. And we might know what will help them achieve that.