There is a great deal of interest currently in the role of the vcs and civil society in Health and Social Care. There are a number of reasons, an ageing and unhealthy population costs more and is unhappier. And as the balance shifts from a young working population to an older, less healthy population public finances will be hard hit as tax revenues decline and spending on health and social care increases.
Early Intervention seeks to spend a small sum on prevention rather than a large sum on crisis intervention – “A stitch in time saves nine”. Social Prescribing is a way of putting healthy activities on a similar footing to pills and medications that one expects to be prescribed at the GPs. By prescribing for example a smoking cessation class, or mindfulness, or exercise, the GP promotes adoption of a healthier lifestyle in a sustainable way and quite possibly saves money not just on that current visit but on the visits in the future as the condition of unhealthy lifestyle takes its toll.
The good news for the sector is that these are all areas that are traditionally our strengths. Many of the groups that have a role are just the sort of groups that the voluntary sector produces in abundance. The less good news is that funding prevention work can be difficult. So on a national scale, reducing smoking leads to less lung disease, a healthier population and less call on acute services. But New Public Management focusses on per unit costs and measurable outcomes which puts prevention work at a disadvantage. At the local scale it is difficult to measure the benefit of a single smoking cessation class. Even if a group of residents give up smoking, the cost savings are still based on guesswork and occur at some time in the future. The residents may even move from local authority area A to B and therefore money has been spent in one area but has ultimately saved money in a different area (and in the future). On the other hand, acute funding and outcomes are much easier to measure. The smoker collapses with a heart attack and is rushed into hospital and after a stay in intensive care is discharged. Everything from the ambulance trip to the point of final discharge can be measured, costed and an outcome clearly measured. But all at much greater cost. So although the costs of prevention are much much lower, on an individual basis the savings and outcomes are much less certain. The answer must be to take a more sophisticated management approach that looks at risks and probabilities based on epidemiological data.
Our Health Advocates project is a type of Social Proscribing that attempts to get around some of the issues such a confidentiality. In our model the volunteer Health Advocate sits in the waiting room of a GP surgery in Camden armed with information about local groups and activities. They are then able to chat to those in the waiting room and suggest a range of activities and groups that they can try, ranging from activity classes to self help groups. This approach gets round some of the problems – GPs would otherwise face such as either having to learn all the options themselves – or have the Health Advocate in the consulting room. Either option presents large issues such as confidentiality. With our approach the patient opts in and and is free to take or leave the advice and signposting offered.
One further issue is that once successful the activities, classes etc that people are being signposted to will gradually have to deal with larger numbers and some small additional funding may be needed. Trickling some small sums of money for this into this part of the system will be the next piece of the puzzle to put into place.
Currently we run a Health Advocates Project, operating in nine GP surgeries in Camden, and we are just about to start an antenatal mentoring project to spread the word about early antenatal care to newly pregnant women from marginalised groups. We also ran a very successful Mental Health Champions project. Sadly our mental health champions project has just closed as the CCG is reviewing this area of work. As a small organisation we are not able to sustain this service while our public sector partners ponder the future – a practical example of why this way of working has much potential but also often falls at the first hurdle.
Other examples of this sort of work in the borough include the Ageing Better Community Connectors project – similar in that isolated individuals are connected to community activity – though in this model the connectors are out in the community rather than sitting in a GP surgery waiting room.
In the past we’ve been part of other projects that have run along social proscribing and early intervention lines, such the Early Cancer Detection Project and the Peer Sexual Health Education Project.
There is great potential for Social Prescribing (in various forms) to be a piece of the puzzle to solve the current health and social care crisis. You can read more about our Health Advocates Project here. There is also a health advocates blog and two case studies; Swiss Cottage GP Practice and another from the perspective of a Health Advocate volunteer.
As part of a borough wide process to look at the future of Health and Social care Camden Council recently convened a meeting of Health, Local Authority and some voluntary sector organisations to co-produce a strategy for Adult Social Care in Camden. The role of social prescribing (in it’s various forms) featured prominently. In a future blog we will look at the work of that group and look further at the role social prescribing could play in Camden in the future.
We have a page of relevant links, case studies and policy briefings on our website here