however there remain difficulties in evidencing the impact of individual models. This paper will consider various .... I
Briefing
Social Prescribing The Role of Social Enterprise
Foreword This is the seventh in a series of Senscot Briefings which aim to showcase the approach that social enterprise is taking to address a range of complex social issues across Scotland. This Briefing highlights the value of social enterprises being involved in social prescribing in terms of the sustainable and person-centred solutions they provide.
What is a social enterprise? A social enterprise (SE) is a trading business – selling goods and services – whose primary objective is to achieve social and/or environmental goals. Senscot recognises SEs in Scotland based on the criteria set out in the voluntary Social Enterprise Code of Practice.
Who are we? Senscot is a third sector intermediary established in 1999. Along with others, we have helped to develop a support infrastructure for SEs over the last 15 years. A key part of our work is to support Social Enterprise Networks (SENs) – geographic and thematic - across Scotland. See senscot.net to find out more.
The context of this briefing The Scottish Government has pledged to introduce an additional 250 community link workers by 2021. This commitment has been accompanied by an eagerness to understand the wide range of social prescribing activity that currently exists in Scotland. Social prescribing is gradually gaining recognition in Scotland for the value of its contribution to tackling pressing social issues including loneliness, social isolation and depression. The role of social prescribing in promoting self-management and community assets in relation to positive health outcomes is a large part of its appeal, however there remain difficulties in evidencing the impact of individual models. This paper will consider various approaches to social prescribing, outlining how the principle values of social enterprise often dovetail appropriately with communityled health programmes. It will also highlight some of the challenges faced by social prescribing and how social enterprise can play its part in finding ongoing solutions – complementing traditional NHS health pathways in communities across Scotland.
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What is social prescribing? Social prescribing is where an individual is connected to services or activities in the community which are likely to help with the health problems they are experiencing. These activities are prescribed as a non-clinical alternative to a medical prescription. Recognising that health is impacted by a range of factors, social prescribing draws on a wide range of community assets to focus on an individual’s physical and mental wellbeing. These include opportunities for the arts, physical activity, outdoor activity, learning, volunteering, social support, mutual aid, befriending services and self-help, as well as support with benefits, legal advice, etc. Social prescribing aims to encourage greater control for individuals and is used with different target groups, but it is regarded as being particularly useful for people with long-term conditions, vulnerable groups and those who are socially isolated.
Approaches to social prescribing Social prescribing is often associated with use by primary care, however it is also used by workers in other services, including social enterprise and the wider third sector. Approaches to social prescribing vary in the ways they connect people to sources of support, the populations they target and the intended outcomes. Levels of support vary across different models, with combinations of the following: • Referrals to generic ‘link’ workers who support people to access and interact with a range of support. • Signposting and connecting people to a broad range of support. • Information-based services to support for self-management. From this there has emerged a range of terms referring to social prescribing, including: Community Link Working, Community Referral, Signposting and Signposted Self-Management. All of these provide a mechanism to: • Support individuals to access resources and support that promote wellbeing. • Increase access to preventative and early interventions for common health problems. • Support those who have on-going health problems.
Documents & Resources • • • • • •
Wellscotland.info Developing a Culture of Health: The role of signposting and social prescribing Gold Star Exemplars: Third sector approaches to Community Link Working across Scotland A Connected Scotland: Tackling social isolation and building stronger social connections Evaluation of the Glasgow ‘Deep End’ Links Worker Programme Engaging Community Assets Final Project Report – Royal College of GPs (Scotland)
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Social enterprise and social prescribing There’s a definite enthusiasm from many social enterprises to become more involved in social prescribing, both in terms of service design and delivery. Much of this stems from a recognition that this approach reflects the foundation of many social enterprises. By taking a person-centred approach, recognising community as an asset and using activities and services to promote social connections, the ethos of social prescribing chimes with the core principles of many social enterprises. For this reason, social prescribing is particularly relevant to social enterprise. A wide range of partners contribute to any social prescribing approach. Being close to the community, developing trust and having the ability to build community capacity is important in establishing a strong partnership – one which appreciates the contribution of all partners. As the case studies later in this Briefing illustrate, social enterprises are already embracing the service design and delivery of social prescription models. Having identified local need, they are developing a range of flexible solutions which can provide various levels of support, including: • • • • • • •
Referring, signposting and connecting to a range of statutory and community activities. Referrals from wide range of agencies/organisations, including primary care. Encouraging self-referrals. Working closely with link worker projects. Supported introductions and interventions. Peer support groups. Information-based support services.
You can click here to see further examples of SEN members engaging in social prescribing activity.
A perspective from a GP “There is definitely a role for social prescribing in primary care. The potential impact on individuals and communities could be significant with the right services in the right locality.” “I believe that small, community health organisations are the best source of social prescribing as they are aware of the community and the facilities and services that are available.” Dr Chris Black, member of the British Medical Association’s Scottish GP Committee
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A perspective from a community organisation Scottish Communities for Health and Wellbeing (SCHW) is a collective of over 70 communityled organisations which deliver services and activities designed to reduce health inequalities in some of Scotland’s most disadvantaged communities. Together, the organisations bring creative and effective solutions to over 300,000 people who are experiencing difficulties which can lead to serious health and wellbeing challenges. SCHW has been involved in developing community-led pilots in Scotland for a number of years and has taken a particular interest in social prescribing. SCHW’s John Cassidy spoke of how social prescribing offers a solution to a widespread problem faced by GP practices across the country: “People sometimes go to healthcare professionals and they want help. Sometimes they’re not even sure why they want help. These can be psychological or social issues and it’s quite well documented that GPs can have a difficulty with that and the normal response tends to be drugs.”
John believes that for social prescribing to fully take hold, health professionals need to have confidence that communities have sufficient assets to be able to fulfil a social prescription: “You have to ensure that there are capacities out there – activities, people, resources that can respond to a social prescription.” In terms of value for money, he is quick to point to the social prescribing model – especially when compared to traditional NHS health pathways. Recent evaluation of ‘Out and About’, one of SCHW’s pilot programmes with a sample size of just under 200 individuals, found that the cost of moving an individual through a community health pathway to a positive outcome came in at around £1000 per person. “£1000 is hugely cost effective in today’s terms. So, yes it’s a very cost-effective way of doing things, partly because you’re using a lot of resources which are already there in communities, you’re using volunteers, you’re engaging with people who have time to work with individuals to see things through.”
John also argued that the model is inherently sustainable: “Social prescribing has a great future because it has the ability to be viable and sustainable if you adopt a model where the funding follows the individual and GPs use some of their own funding to help that happen. Community organisations, where they provide services and activities, can benefit from the funding coming along with the individual – that helps sustainability.” SCHW have entered a joint bid for £5m of Big Lottery Fund award money, alongside the Healthy Living Centre Alliance (HLCA) in Northern Ireland. If the bid is successful, the money will be used to invest in accelerating the use of social prescribing across more communities in Scotland and Northern Ireland. Optimistic about the future of social prescribing, John expressed a desire for it to eventually be formally adopted by the Scottish Government: “We want to see community-led health improvement as part of a national strategy, and that each year a budget is allocated for community-led health improvement.”
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Maximising the impact of social prescribing We asked social enterprises to make their recommendations for what would improve social prescribing activity in Scotland, and how its impact could be maximised.
Value community and existing resources • • • •
Genuinely value communities and their strengths, recognising a local focus at a neighbourhood level. Remember there are lots of existing opportunities and resources at a local level. Make the connections between the existing activities and services to maximise their impact. Invest in community capacity building.
Widen understanding of need • • • •
Recognise that different tools are needed for tackling different conditions. Some different or less well-known activities are not considered appropriate e.g. community radio. These should not be excluded. Identify and address gaps in service design and planning. Extend the reach and scope of social prescribing interventions.
Strong partnership working • • • •
A shared understanding of social prescribing is required to harness collective action. Appreciation & recognition for the contribution that all partners bring, including the local community. Support for partners to work more effectively together towards a shared purpose and ownership. Recognise the barriers faced by all potential partners.
Realistic resourcing of social prescribing • • • •
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Invest resources to ensure capacity exists to meet the increased levels of demand. Embed sustainability through ensuring that funding follows the individual. Explore collaborative investment and disinvest in some services and parts of the system to reinvest elsewhere towards improved outcomes. Improve recording of outcomes to create evidence. Although it takes time to gather information, evidence is needed to tackle potential bad press on alternative spending of NHS money.
Case Study 1 Clydesdale Community Initiatives (CCI)
Mission Clydesdale Community Initiatives’ core mission is to empower individuals with a range of support needs, skills and experiences to make a tangible contribution to their community.
Main activities CCI’s person-centred model engages in alternative, non-clinical activities which utilise an individual’s strengths, experiences and aspirations. The focus is on providing real inclusion, real work and real value to the communities CCI support. CCI seeks to work collaboratively with like-minded partners from across the statutory, private and third sectors to create a model of social prescribing in South Lanarkshire that will actively listen, adapt and respond to the local community’s needs and ambitions. On a day to day basis, participants and volunteers are supported to engage in a range of enterprise and inclusion activities such as soft and hard landscaping; horticulture; wood crafts; micro-enterprise; and food growing and processing. CCI operates an open referral process, meaning that individuals can self-refer,
but a wide number of agencies can also make referrals - social work departments, local community mental health teams, education and other third sector organisations. There are no time limits on CCI placements, meaning individuals can explore their capabilities at their own pace in a supportive environment. CCI has developed strong relationships with a variety of organisations to develop projects and activities that respond to the community’s needs.
Business Model Just over half of CCI’s income is generated from enterprise activities and social care contracts. A small number of individuals also currently utilise their self-directed support to engage in CCI activities. Their remaining income comes from various grant making foundations and trusts including The Robertson Trust, and the Big Lottery Fund. CCI has a strong relationship with NHS Lanarkshire and is currently working to create greenspaces on four NHS Lanarkshire sites. This mix of revenue ensures that people who do not have a social work budget can access CCI’s placements free of charge.
Social Impact 76% of participants felt positive about their future.
Current partners include NHS Lanarkshire community mental health teams; third sector agencies; NHS Lanarkshire’s AHP network; South Lanarkshire Council’s social work services; environmental agencies including Scottish Wildlife Trust; and local employability agencies such as Skills Development Scotland.
In 2016/17, CCI worked with 107 individuals and delivered 4,972 volunteering sessions. From a total of 65 new referrals in 2016/17, roughly a third were from local community mental health teams. Internal evaluation revealed that in 2016/17, 76% of participants marked an improvement in their mental health and wellbeing, while 76% felt more positive about their future.
Clydesdale Community Initiatives Fact File Established: 2003
Turnover: £1,453,175
Workforce: 8 FT and 8 PT staff
Legal Structure: Company Ltd by Guarantee with charitable status
www.cciweb.org.uk @CCInitiatives facebook.com/ ccilandscaping
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Case Study 2 The Care and Wellbeing Cooperative
Mission The Care and Wellbeing Cooperative (CWC) is a local group of self-employed carers, professionals, therapists and wellbeing specialists who together work to give people in rural Perthshire greater flexibility and choice over the support and wellbeing services available to them.
A pilot was set up to explore how CWC could offer its services through social prescribing. The pilot forged a link between CWC and the local GP surgery, using money from PKC’s Befriending Project fund – roughly £4,500. 10 patients were involved with the pilot, being referred to a range of CWC’s activities including photography, gardening, etc
Main activities In 2012, the community-based support enterprise GrowBiz was invited by Perth and Kinross Council (PKC) to submit a proposal to support innovative, local and individual services to people with support needs in rural areas. This was in direct response to the Scottish Government’s Bill advocating self-directed support. CWC has grown into a local group of 30 self-employed carers, professionals, therapists and wellbeing specialists who offer a range of personalised alternatives to clinical treatment to deliver a person-centred approach to wellbeing. Members offer services such as befriending, nature walks, photography lessons, gardening projects, community herbalism, yoga and therapeutic creative writing.
Business Model The social prescribing project was funded by PKC Befriending Project (£4,500) and also money from a Participatory Budget process (£1,200). Members who provide services are also paid through SDS Option 1 or people use their own benefits or resources to pay members, depending on the service. Rates vary from £15 £45 per hour.
Social Impact
Gardening is one popular activity at the Co-op.
depending on their interests and goals. Despite the small sample size, the project was thought to have been a positive experience by all, with GPs experiencing a noticeable improvement in each patient’s wellbeing. CWC currently receives referrals from a range of sources, including self-referrals, GPs, community nurses, social services, carers and community organisations. After the initial pilot, CWC continues to receive 2-3 referrals from the participating GP’s surgery each month.
Research commissioned by CWC after the pilot concluded that the programme should be opened out so that more patients can take part. The Edinburgh-Warwick scale was adopted to measure the success of the pilot, with each patient’s wellbeing measured before, during and after the pilot. The pilot ran for three months with 9 out of 10 patients recording an improvement in their wellbeing, which the GPs found hugely encouraging. Further, GPs reported that investing in social prescribing would be a mutually beneficial way for the practice to handle patients who were perceived to be ‘needy’, freeing up appointment spaces.
The Care and Wellbeing Cooperative Fact File Established: 2014
Turnover: £39,542
Workforce: 1 PT post – 27 freelance members
Legal Structure: Company Ltd by Guarantee
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thecareandwellbeing.coop @CareCo_op facebook.com/ careandwellbeingcoop
Case Study 3 The Good Morning® Service
Mission The Good Morning® Service (GMS) aims to help every older person in Scotland feel safe, connected and valued.
Main activities GMS helps older people retain their independence with a light-touch package of support delivered over the phone in the form of ‘befriending sessions’. Members receive a call each day at a pre-arranged time, building up a trusting relationship with the GMS staff over time. The calls, provided 365 days a year, are designed to provide practical and emotional support which meets health, social care and safety objectives. GMS strives to ensure that members receive a continuity of care, proactively keeping track of members who go into hospital and working to coordinate the service with discharge dates. GMS also offers a safety net alert service – in the event of a call going unanswered, a nominated contact will be alerted. In instances where a member’s safety cannot be verified, Police Scotland will be notified. GMS
also double check that health appointments have been attended. To help prevent instances of burglary, GMS works in partnership with Police Scotland to warn members of criminals believed to be working in specific areas. Warnings are passed on to members, along with up-todate advice on good doorstep management and scam avoidance. Members get the opportunity to meet and mingle at a social outing each month, while a monthly newsletter keeps members clued
Business Model Both grant funding contracts and service level agreements are entered into with public bodies. GMS can be purchased via Public Contracts Scotland or funded directly where appropriate. Securing independent grants helps GMS ensure that the investment made by local authorities is returned not just in the positive outcomes for older people and local communities, but in the leverage gained from public spend. The public can also purchase the support service from 2 up to 7 days a week.
Social Impact
Members build a trusting relationship with GMS staff.
up on local services and key NHS articles. Where GMS is unable to meet a member’s needs, a community directory can signpost services and events, such as NHS classes on managing long-term conditions, community links practitioners and Community Connectors. Referrals from health and social care partners currently make up 75% of its waiting list.
The most recent annual internal evaluation to be conducted was returned by 173 service users. The survey indicated that 100% of respondents felt ‘safer at home’, felt ‘better connected to their community’ and felt ‘cared about’ due to the befriending calls. A further 99% of respondents experienced reduced feelings of isolation and loneliness, as well as an improvement in their overall sense of wellbeing.
Good Morning Service Fact File Established: 2000
Turnover: £255,000
Workforce: 2 FT staff, 16 PT and 7 volunteers
Legal Structure: Co Ltd by Guarantee with charitable status
goodmorningservice.co.uk @Good_Morning_2U facebook.com/ thegoodmorningservice
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