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Social prescribing for well-being: how nurses can combat loneliness and isolation

Connecting people to support and services is more important in the wake of COVID-19 than ever

Connecting people to services and community groups is more important in the wake of the pandemic than ever

  • Social prescribing pilot programmes have shown a big impact on peoples lives, yet engagement with the process across the nursing workforce has been limited
  • The NHS Long Term Plan in England aims to have 1,000 social prescribing link workers in place by 2021 and at least 900,000 people being referred to social prescribing by 2023-24
  • Benefits for individuals include improved mental health, greater independence, reduced isolation, increased physical activity and engagement within local communities
Social prescribing can help connect isolated people to their communities Picture: iStock

With more than nine million people in the UK saying they are always or

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Connecting people to services and community groups is more important in the wake of the pandemic than ever

  • Social prescribing pilot programmes have shown a big impact on people’s lives, yet engagement with the process across the nursing workforce has been limited
  • The NHS Long Term Plan in England aims to have 1,000 social prescribing link workers in place by 2021 and at least 900,000 people being referred to social prescribing by 2023-24
  • Benefits for individuals include improved mental health, greater independence, reduced isolation, increased physical activity and engagement within local communities
Social prescribing can help connect isolated people to their communities Picture: iStock

With more than nine million people in the UK saying they are always or often lonely, can social prescribing be part of the solution to this complex public health issue?

Social prescribing means connecting people to community groups and statutory services for practical and emotional support.

Beccy Baird: ‘Social prescribing is about
linking people to their communities’

A lifeline for those coping with feelings of isolation or hopelessness

‘It’s not a panacea,’ says Beccy Baird, a senior fellow at the King’s Fund think tank. ‘Social prescribing is often open to interpretation and can be used as a catch-all term.’

But for those needing spiritual care in its broadest sense – care that might help them combat the mental and physical health implications of social isolation and feelings of hopelessness, or support them with bereavement or chronic health conditions – it may provide a lifeline.

And as we begin to understand the impact on individuals and communities of the COVID-19 lockdown, the many deaths due to the virus, and the illness itself for those recovering and their families, such measures seem even more timely and pressing.

Connecting people with the communities they live in

Social prescribing is attracting increasing investment. Part of the NHS Long Term Plan in England includes having 1,000 social prescribing link workers in place by 2021, with more to follow. Plus there’s a target of at least 900,000 people being referred to social prescribing by 2023-24.

‘If you have a long-term condition, chances are you will spend a tiny percentage of your year talking to health services, but an enormous amount of time living with that condition day to day in your community,’ says Ms Baird. ‘So social prescribing is about helping people live their best possible lives, linking them to their communities and supporting those who find it more difficult.’

Its success or otherwise depends on a variety of factors. ‘You can have good social prescribing link workers helping to connect people into their communities, but services need to be there for them to connect with, as the two go hand in hand,’ says Ms Baird, who highlights the funding cuts experienced by many voluntary organisations.

It is also not enough to give someone a piece of paper with details of where a local group meets.

‘You need to understand people’s motivation and why they might not have accessed help beforehand,’ she says. ‘It’s much more nuanced than a social prescription.’

The Men’s Shed project: restoring connection and a sense of purpose

While there were several good local support groups for women, practice sister Sarah Everett felt men in her area were missing out

‘For some male patients, there was a lot of isolation, depression and feelings of worthlessness,’ says Ms Everett, who works at a health centre in Govan, Glasgow.

‘They were bored, with nothing to do all day and no purpose in life. A lot had worked in male-dominated industries and they missed the camaraderie. I thought there could be so much more for them.’

Coincidentally, she’d had an email inviting her to apply for a grant from the Queen’s Nursing Institute Scotland to start a community project. ‘I thought, go for it,’ recalls Ms Everett, who won RCNi’s Patient’s Choice award in 2019.

Govan Men’s Shed has been a lifeline to the men who use it Picture: Mike Wilkinson

At the outset, she brought together six patients whom she thought would be interested in helping set up a centre for men. They jumped at the chance. An old nursery that had been derelict for seven years became the perfect base, especially as it had a large garden.

‘The men started cleaning and revamping it,’ says Ms Everett. ‘It had weeds three feet high.’

Sarah Everett Picture: Mike Wilkinson

Today the Men’s Shed has a well-tended vegetable garden, with raised beds and a poly tunnel, and offers a variety of different classes, including arts and crafts, and exercise.

It’s open for three days each week and about 40 men attend regularly, some at the suggestion of nurses and GPs. Although it has been closed during lockdown, the men have been keeping in touch by phone, with some going in on their own to take care of the garden.

‘It has changed lives,’ says Ms Everett. ‘There was one man who didn’t see the point of going on. But he developed an interest in the garden and he’s there almost every day now, looking after the plants.’

Another in his eighties had struggled to cope following the death of his wife, who he’d looked after for more than a decade.

‘He was lost,’ says Ms Everett. ‘His family dragged him to the Shed – he didn’t want to come – but now he loves it. He irons his clothes and comes down to see lots of friends, whereas he wouldn’t get out of his pyjamas before.’

Data on the benefits of social prescribing

Evidence about the effectiveness of social prescribing is gradually emerging, pointing to improvements in patients’ well-being.

This includes an evaluation of one of the UK’s largest social prescribing pilot programmes, in Rotherham, which took place between 2012 and 2014 and involved more than 1,600 patients.

Data show that after three to four months, 83% had experienced positive change.

Specific benefits include improved mental health, greater independence, reduced isolation, increased physical activity and better engagement and participation in local communities.

Social prescribing works when care is personalised

Taking a person-centred approach to social prescribing is crucial, says Michelle Howarth, a senior lecturer in nursing at the University of Salford and lead at the Nursing Social Prescribing Special Interest Group. She is one of the core team leading the Salford Social Prescribing Hub, which aims to identify and share best practice, evaluate the benefits of social prescribing, map local services and develop training and resources.

‘If you divorce social prescribing from the personalised care agenda, it just becomes a system and a process,’ she says. ‘It may well be that someone is lonely, overweight or suffering with anxiety, but until we understand why that’s happening to that individual, we can’t begin to support them. The true value of social prescribing lies in that person-centred holistic approach.’

Setting up a social prescribing scheme: where to start

Be aware of social prescribing as an option ‘If we’re referring someone to the district nursing team, why can’t we pick up the phone to a link worker?’ says Nursing Social Prescribing Special Interest Group founder Michelle Howarth. ‘When we’re discharging someone, we can ask if they’ve thought about some local services that could help’

Make sure you have support Before launching your own social prescribing scheme, make sure you have people in your team who have bought into the project. ‘You’ll always have knock backs,’ says practice nurse Joyce Pickering. ‘You need at least two or three others who are as committed as you to making it a success’

Collate evidence from the beginning ‘Have some sort of scheme in place to measure your data,’ says Ms Pickering. ‘I didn’t want to cost the practice money on something that isn’t working – and collecting quantifiable data is the only way to know, helping you justify it, if you need to’

Check what’s available locally – and don’t reinvent the wheel ‘We learned so much about the good services happening nearby,’ says Ms Pickering

Remember that anyone could potentially benefit from a social prescription While the focus has been on those with mild to moderate mental health issues, including social anxiety, older people who have become isolated, and people with longer-term conditions, there is work to involve younger people now, helping to improve their mental well-being, says Dr Howarth

Work in partnership with your patient and understand their starting point. ‘It’s not about saying, here’s a list of things you could do,’ says the King’s Fund’s Beccy Baird, ‘but thinking about your patient’s needs and exploring potential solutions together’

Raising the profile of social prescribing

After attending a social prescribing network meeting a couple of years ago, Dr Howarth was surprised at the lack of nursing involvement.

‘I was shocked that nursing didn’t seem to be engaged. It wasn’t hitting the radar of any of the big organisations,’ she says. ‘We’re the biggest workforce in the NHS and I felt we should at least be aware of it.’

To improve understanding, she set up a nursing in social prescribing special interest group, which now includes representatives of the Queen’s Nursing Institute, RCN, Health Education England, eight universities and other organisations.

‘We’ve been trying to raise the profile of social prescribing,’ explains Dr Howarth. ‘It’s starting to gain a foothold now in the profession, gaining momentum with an emerging language. But there’s still a way to go.’

A framework for students and healthcare professionals

The group is developing a joint educational framework to enable nursing students and other healthcare professionals to have placements with organisations that offer social prescribing.

‘It will help them understand what it’s all about and how it supports people in the community,’ Dr Howarth explains. ‘We’re trying to highlight that it’s not all about fixing people, giving them a pill, but about understanding well-being in a much broader sense.’

A scheme for frequent attenders: ‘I wanted patients to feel empowered’

For nurse manager Joyce Pickering, seeing patients who came back to the GP surgery where she works time after time but never seemed to make progress motivated her to act.

Joyce Pickering

‘We’re good at prescribing medications, but sometimes we’re not so good at spending time with patients – that’s partly because we don’t have it,’ says Ms Pickering, who works at the Cricketfield Surgery in Newton Abbott, Devon.

After completing a leadership course run by the RCN, she decided to set up a scheme to help patients who were frequent attenders, including those who she felt were struggling to get their lives back on track, perhaps after the loss of a partner, cancer treatment or the diagnosis of a long-term condition such as diabetes.

‘I thought I could do some research, see what’s happening locally and whether we could address some of these social needs,’ she says.

She was also keen to achieve tangible benefits for patients’ overall health too.

‘I was looking for a holistic approach,’ says Ms Pickering, a committee member on the RCN general practice nursing forum. ‘I wanted them to feel more empowered but for there to be a clinical aspect too – for example, how did what they choose to do affect their blood pressure or weight.’

A 12-week scheme where people have time to listen

The scheme has been running for just over a year and nurses and GPs can make referrals to it. Patients can attend up to 12 half-hour, weekly appointments with a trained and experienced healthcare assistant. They can be prescribed anything from attending various groups to exercise programmes and keeping food diaries that help them make better food choices.

‘For those 12 weeks, it’s all about them,’ says Ms Pickering. ‘What they want to do, what are their goals and how can we help. A lot of it is trying to find out why they are struggling so much and what might inspire them to make a change.’

‘If you start to feel better about yourself, you’re in a better place to consider making some changes’

Joyce Pickering, nurse manager, Cricketfield Surgery

So far, feedback has been overwhelmingly positive.

‘One person said, “for the first time in about three years I feel I can make my own decisions about my health and I’m back in control”,’ she says.

There have been few non-attenders. ‘It surprised us that the rate is so small,’ says Ms Pickering. ‘We choose the patients carefully. If we think someone will benefit, we’ll ask if they’d like more time to talk something through, as it seems they have a lot going on in their lives at the moment.’

Looking ahead, the practice is interested in seeing how it can offer more support to lone parents, a group that often experiences social isolation.

‘One of the things I heard a lot from those who have gone through our programme is it’s nice to have someone to listen and not rush me out of the door,’ says Ms Pickering. ‘If you start to feel better about yourself, you’re in a better place to consider making some changes.’

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