How secondary care can benefit from the social prescribing revolution

Social prescribing is a way of tackling the social, economic and environmental factors that affect our health and wellbeing. Clinical teams refer their patients to a link worker, who helps the patient think about 'what matters to me'. Together they set goals and take steps towards achieving them. Many of these goals involve connecting patients to support, groups and activities, particularly in the voluntary and community sector. This approach provides a preventative and community-based model of care for patients, by tailoring the response to meet the individual's needs in a more holistic way than traditional healthcare delivery.

Although social prescribing is common in primary care, there are fewer examples in secondary care settings, and the benefits to NHS trusts and wider integrated care systems are not well understood. But there are welcome commitments from the new government on prevention and a focus on the management of long-term conditions.

Social prescribing in primary care can reduce costs in secondary care

At Ways to Wellness our mission is to develop and test innovative programmes and prototypes that improve health and wellbeing, tackle health inequalities, and reduce demand on NHS services. We launched in April 2015 in the west of Newcastle upon Tyne, where deprivation is higher than average, life expectancy is lower and people with long-term health conditions experience high rates of unplanned admissions to hospital.

We wanted to test whether social prescribing in primary care could demonstrate two outcomes: (a) improving health and wellbeing for people living with long-term conditions; and (b) reducing NHS costs related to their care.

Improvements to patient wellbeing were measured six-monthly using the Wellbeing Star^TM. In the first five years patients, on average, improved their wellbeing on the Wellbeing Star^TM by 3.4 points, an increase of 11%.

The financial impact on secondary care was calculated by comparing the difference between the average spend per head for the Ways to Wellness cohort in Newcastle West and a matched counterfactual cohort in Newcastle North and East (patients from both cohorts use the same trust). The difference is then scaled to account for the proportion of engaged patients.

For the 12 months ending August 2019 (latest data available) the average 12-month spend for the full eligible Ways to Wellness cohort was £156 per head (or 13%) less than the comparison cohort. Across the Ways to Wellness cohort (14,652 patients) this difference equates to £2.4m less in annual spend compared to the control cohort. When costs are adjusted to account for the proportion of the Ways to Wellness cohort that has engaged on the Ways to Wellness service, the Ways to Wellness engaged cohort 12-month per head spend is 51% less than the control cohort.

Table 1: Secondary care average spend per head: Ways to Wellness and control cohorts

*year five annualises five months of data (April – August 2019) to represent a full year for comparison purposes.

Our predicted longer-term impact is also expected to be significant. Research has found that improving a patient's 'self-care' leads to reduced use of hospital services. Long-term benefits for patients include sustained improvements in physical activity and reductions in loneliness, lasting for 20 years.

Honestly it was the turning point in my life; because I had reached rock bottom and I just needed practical help to try and get back up.

Ways to Wellness patient    

Placing link workers in secondary care

There are emerging examples of trusts embedding social prescribing within their secondary and tertiary care services. Great North Children's Hospital has placed link workers to support families with children with neuro-disability to provide support while the child is an inpatient, enabling direct engagement with secondary care staff.

Initial evidence suggests improvements in wellbeing for patients and relieving pressure on hospital staff, who often don't have the knowledge or time to provide support provided by link workers.

We encourage trusts, and wider health systems, to consider the role that social prescribing can play in improving care for patients, preventing ill health, reducing health inequalities, and alleviating pressure on already stretched NHS services. Social prescribing approaches could be considered alongside other community-centred prevention initiatives, such as health hubs. It is also important that we continue to test how link workers can best support secondary and tertiary care services.