Social prescribing and digital technology. 8 ... Jeremy Hunt in speech at the National Children and Adults Services (NCA
Social prescribing and older people Guide to Developing Project Plans November 2014
Contents
Note on definitions 4 Social Prescribing and Connectedness 5 Social prescribing in older age 5 Developing a social prescribing approach 6 Empathy - the first conversation 6 Mapping local assets 7 Finding, understanding and using information 7 Evaluation 8 Social prescribing and digital technology 8 Presentation of local plans 9 Suggestions for including in Ageing Better project plans9 Resources to support plans 12 References 16
2
Ageing Better Social prescribing and older people Guide to Developing Project Plans
“Isolation is being by yourself. Loneliness is not liking it.”1
Christine Hoy Primary Care Development Manager Health and Social Care Alliance Scotland For the Ageing Better Support and Development Team November 2014 Ageing Better Social Prescribing v2
1 Quote from: Isolation:
The emerging crisis for older men, Brian Beach and Sally-Marie Bamford, Independent Age and the International Longevity Centre UK (ILC-UK), 2013
3
Note on definitions For the purposes of this guide, the terms “social prescribing” and “referral” are used, however these terms are considered by many to be too clinical and not appropriate to describe a more social, co-created model of health (for this reason some prefer terms like “community connecting” and “signposting”). Social prescribing is simply a way to link people to (usually) non-medical sources of support. Although often associated with exercise and art prescriptions in primary care, the term represents linking people to whatever they think keeps them well. This may be formal or informal and can mean anything from meeting people for a coffee, making contact with others by phone or online, accessing financial support or being linked to organised clubs and groups.
4
Social Prescribing and Connectedness The apparent mismatch between available support and level of need may be as much to do with a lack of connectedness as a lack of support. The potential for advances in our caring systems, simply through strengthening connections in local and national networks, will be seen in Ageing Better projects. Being connected to others has a high value for all of us living, working and being cared for in communities, but this sense of connection is especially precious for older people and those who are living alone or in deprived circumstances. Social prescribing is part of a wider movement which heralds the beginnings of a slow shift from a traditional top down, reactive caring system, towards a less bureaucratic networked approach, better suited for persisting and worsening health inequalities. Social prescribing can accelerate this shift as it is a systematic approach which places a value on relationships, helps to demedicalise health and contributes to the common good.
Social prescribing in older age “My mother’s name was Joan Whitelaw. She had been: a daughter, a sister, a wife, a mother, a friend, a workmate, a neighbour, and a valued member of her community. Six years ago, I walked out of a hospital with my mum after her diagnosis of dementia and we walked out alone, with no support. For this reason I am committed to raising awareness of the impact of dementia on families so that nobody else should have to go through the loneliness and isolation that I did. People don’t 2 know that there’s support out there, helping them get it really makes a difference." Many people think that linking people to support is already happening in communities, however 3 Ageing Better projects are being set up precisely because vital connections are not being made, at least not on a large enough scale. Older people are particularly vulnerable. Although there are many positive aspects of growing older, ageing is too often associated with poor health and loneliness. Changing circumstances such as loss of family and friends and retirement, can lead to isolation. Jeremy Hunt MP, Secretary of State for Health, recently acknowledged as a society we have “utterly failed” to confront the 4 problem of loneliness, labelling it a “national shame”. Loneliness has been described as an urgent public health issue, by the Campaign to End 5 Loneliness , a coalition of organisations working to address the problem. There is growing 2
Tommy Whitelaw; Dementia Carers’ Voices Health and Social Care Alliance Scotland http://www.alliance-scotland.org.uk/what-wedo/projects/dementia-carer-voices/ 3 http://www.biglotteryfund.org.uk/global-content/press-releases/england/080914_eng_ab_lottery-82m 4 Jeremy Hunt in speech at the National Children and Adults Services (NCAS) conference, October 2013, http://www.bbc.co.uk/news/ukpolitics-24572231 5 Campaign to End Loneliness http://www.campaigntoendloneliness.org/
5
academic interest in the detrimental effects of loneliness as research uncovers more about the 6 7 scale and impact on health and social care services. The Ageing Better investment is important as it utilizes the wisdom of older people and facilitates their positive contribution. Older people are central to development; many will be working and others may welcome a long awaited opportunity to develop new interests. Projects not only presents a way to tap into a huge pool of experience, but a way for older people to be active contributors, ensuring projects are based on lived experience, and not on a traditional delivery model.
Developing a social prescribing approach Ageing Better should be regarded as a whole system approach rather than one off projects; teams should ensure that social prescribing initiatives are sustained through engaging support of local groups, such general practices, voluntary and third sector organizations. This will encourage local relationships, joint learning and sustain systems beyond the project time limit. The very simplicity of a social prescribing approach belies its challenges. Social prescribing doesn’t just happen, it requires an awareness of the value of every single contact with other human beings, empathy, skills in finding, understanding and using information (information and health literacy), a knowledge of local sources of support, organizational, digital and technical skills. While developing plans, those involved should consider their own wellbeing. Introducing change needs energy and a flexible approach therefore protected time should be allocated for reflection and sharing stories which may lead to valuable adjustments and improvements in plans.
Empathy - the first conversation Linking people to support requires empathy and an awareness of the social context of health and individual belief systems. Making special connections requires patience, an ability to listen and judge how and when to introduce new ideas. Signposting older people to support may mean having difficult conversations, as they may feel emotional, embarrassed and find it hard to articulate their feelings. Considerations should be given to details such as what words to use, what approach to take in someone’s home, how to have conversations with an interpreter or carer present, how to explore options, share information, prioritize issues, how to take account of complex needs. This requires consideration of social, emotional and practical support such as experienced in the Yorkshire and Humber Age UK Social Prescribing Pilot: 8
The Yorkshire and Humber Age UK GP Social Prescribing Pilot is a partnership between the voluntary sector and GP practices. The aim of the pilot was to assess the effectiveness of social
8
http://www.ageconcernyorkshireandhumber.org.uk/uploads/files/Social%20Prescribing%20Report%20new.pdf
6
prescribing for older people who were lonely and socially isolated or had mild to moderate depression. The project worked with 12 GP practices and 6 local Age UKs across Yorkshire and Humber. Participating GPs referred 55 older people to the Social Prescribing Service at their local Age UK. The service provided an in-depth assessment of social, emotional and practical support needs and helped older people access the services including befriending, social groups, benefit checks, fitness classes, community transport, handyman services, local community groups etc. The older people supported through the Social Prescribing Pilot Project reported significant improvements in their emotional well-being.
Mapping local assets Mapping local assets is a useful way to meet others in the community with a common purpose – to form relationships, exchange local knowledge and contribute to local information directories. Assets can be mapped with any number of people and can start by inviting participants to think 9 about “what helps you to keep well?” Participants are encouraged to share their own personal experiences and recommendations of activities, places, organisations and examples of what they do to be healthy and happy. Mapping assets will help to:
prompt conversations about keeping well in older age and avoiding isolation reveal ‘hidden’ services, activities and places prompt people to think about who and what’s in their local network how they might link with local people, group and services generate ideas on how to share this information develop ideas about how to use local information
Finding, understanding and using information Accessing support can be as important and life changing as medications, but in order to link people to sources of support, there must be a way to find them. Projects will require an open system of accessing local resources that is easily understood and available in accessible formats. Most communities have a network of hubs offering useful support for older people, such as libraries, faith communities, schools, general practices, voluntary groups and community clubs. However less formal resources may not be well known and may not be connected. In Scotland, A Local Information System for Scotland (ALISS) has been developed to address this issue by improving access and visibility of local resources. ALISS is a digital innovation co-produced with people with long-term conditions, disabilities and poor literacy to address the problem of gathering, maintaining and sharing information about local sources of support. ALISS has been developed in an open approach, using open source technology to provide a means for people and communities to contribute and share their knowledge of local resources (assets). The system is attracting support of professionals who understand the potential for a sense of connectedness, developed through social prescribing, to 9
ALISS resources, http://www.alliance-scotland.org.uk/what-we-do/projects/a-local-information-system-for-scotland-aliss/aliss-resources/
7
improve health and wellbeing. Dr Graham Kramer, a General Practitioner in Montrose, is seconded for two days a week to the Scottish Government as National Clinical Lead for Self Management and Health Literacy. Graham uses ALISS within his practice system to signpost his patients to local support in the community. “ALISS is transforming me as a doctor. All my years of training has encultured me to help and try and do things for or to people yet I’m realising, with people living with long-term conditions, that my medical options are extremely limited. When you explore ALISS you begin to realise a whole wealth and community of options that I didn’t know existed. It’s a powerful reminder that what I do is important but somewhat of a side show compared to what people can do for themselves. It has shifted my own conversations with people from what’s wrong with you to what keeps you well?”
Evaluation Projects should collect local data as early as possible for baseline evaluation. This could include for example: population profile, with number of people over 50 years, number employed, number housebound, number living alone indexes of deprivation data on health of community people who most need support, for instance those who may be at increased risk of loneliness. (The Coming of Age10 report cites relationship status, especially being divorced or widowed, time spent alone, poverty, a history of loneliness and poor health) number of older people discharged from hospital number and nature of voluntary, third sector and statutory services size and nature of local faith, ethnic and LBGT communities number of directory of resources, sources of formal and information about events, clubs, social activities such as shop windows, poster boards, faith community newsletters, local newspapers description of existing signposting/ link working systems existing or past audits of local social prescribing activity Audit of current pathways from general practice, social care, Citizens Advice, voluntary sector etc to resources on support and information
Social prescribing and digital technology One of the biggest changes in our lives in recent years has been the advance in digital technologies. However, the benefits of the digital revolution are still to be shared with many older people whose only experience may be with assistive technologies, like home emergency alarms 10
“Ageing is not a policy problem to be solved: Coming Of Age, Louise Bazalgette John Holden Philip Tew Nick Hubble Jago Morrison www.demos.co.uk
8
and monitors. Harnessing new technologies is an exciting dimension a social prescribing approach as it facilitates contact with others, signposting to activities such as introductory computer courses, accessing sources of support, learning new skills, finding information. Ageing Better projects should seek opportunities to collaborate with local initiatives to promote digital 11 inclusion. Wiltshire Online is an excellent example of how everyone in the community is getting together to share knowledge and experience of using computers: Thanks to the excellent work carried out by volunteer coordinators and digital champions, Wiltshire Council is seen as a leader in the field of digital inclusion. Mike Strong is a volunteer coordinator and digital champion for the Devizes community area. After working in IT, Mike decided to put his IT skills to good use by getting involved in a local project. Mike now heads up a team of digital champions and has approximately 30 learners on his books at any one time and receives all sorts of requests for help. Now Devizes School, the sixth formers and Mike are delivering free computer support every Monday in Devizes Library and another recent initiative is working with residents in a sheltered housing complex. Mike has started providing one to one support for residents who registered for help with the Wiltshire Online programme. This has generated a lot of interest amongst other residents and discussions are currently ongoing about running some group sessions for them.
Presentation of local plans Older people are to be involved in all aspects of design and delivery of the project which will ensure that local plans are presented using an appropriate vocabulary. Choosing the right words for Ageing Better materials may be challenging, for instance, many over 50’s will be insulted by the use of the word “old”, “older” “ageing” and “elderly” for and won’t associate the term as 12 having anything to do with them. (Group participants in the Mass Observation project did not wish to be targeted for activities aimed at older people, however, the majority were enthusiastic users of universal services such as libraries, leisure centres and other community facilities). Applying words such as “volunteer” to people who are helping out in informal clubs may indicate a subtle change in the nature of their contribution and introduce an unwelcome element of commitment and organization.
Suggestions for including in Ageing Better project plans Timelines Project plans should include a timeline to indicate start and finish dates for stages of the project
11
Wiltshire Online http://www.wiltshireonline.org/ 12 Brunel Univ Mass Observation project – http://www.newdynamics.group.shef.ac.uk/assets/files/NDA%20Findings_28.pdf
9
Context National context - how plan contributes to current wider policy for future models of care for older people Projects will be major contributor to plans being drawn up by local Clinical Commissioning Groups (CCGs) – who are tasked with drawing up robust plans for improving care in 13 communities Local context - how plan fits with local civic conversations (eg local development plans for environment, transport, local authorities, housing, community groups, health and social care etc).
Governance and accountability Reference to how project will address risk, for example policy to follow if volunteers/signposters are party to confidential information and clear plan for mechanism for reporting Governance of project (setting out Terms of Reference, membership of steering group, setting up reference groups etc) Plan for reporting – who to and at what intervals
Plan for local evaluation Plan for collecting local data which will compliment central evaluation measures
Local collaboration Plan to enlist support of local “town criers”; they are usually well-known, skilled communicators, who are part of large networks. For example they may be volunteers in lunch or sports clubs, health visitors, librarians, Describe how project intends to involve staff who have contact with older people in their homes (eg voluntary sector, community nurses, social care workers, gardeners, postmen, community police, pharmacists, community development workers, mental health teams). Identify others locally who share core objectives and aim to collaborate for mutual benefit. For example, groups planning to improve integration of health and social care, education, local public services Projects should seek to collaborate with local e-health and digital innovation strategies for mutual benefit Involving all age groups - for instance librarians, pupils and staff can join in asset mapping workshops, helping older people with digital technology, encouraging all to be signposters.
13
Everyone Counts: Planning for Patients 2014/15 – 2018/19, NHS England, 2013, http://www.england.nhs.uk/wpcontent/uploads/2013/12/5yr-strat-plann-guid.pdf
10
Training and Support Consider whether there is a need for training and support for project participants. For instance, developing skills in therapeutic conversations, working in deprived areas, talking about debt, crisis, poverty, dying, forming local relationships, meeting people from very diverse health beliefs and cultures, accessing online resources, how to signpost, individual and community health literacy, asset mapping, information literacy etc Training in the role of advocacy should be considered; social prescribing will be an important factor in helping older people to access information about financial benefits, energy costs, employing help in the home etc.
Addressing practical issues Plans should set out priorities to establish the most urgent need. For example this may be practical activities such as providing information / making templates / sticky labels. Identifying the project “home” (could be in library, local community hall, general practice, voluntary sector organisation) rd Consider the capacity of voluntary and 3 sector groups to cope with an increase in signposting to their resource Address sustainability, Ageing Better projects should plan to integrate with existing networks and not appear to be a well intentioned new project Take care not to disrupt existing initiatives, for instance, groups who prefer not to include others or who cannot cater for an increase in numbers How to keep directories of local information up to date Developing existing or new pathways, electronic / paper based Setting criteria for social prescribing (any exclusions?) Choosing models of community connectors / link workers Methods of commissioning from both non-statutory and statutory sectors Developing a model for commissioning non-traditional providers (see example in Thanks for 14 the Petunias ) Method to send and receive referrals Method to collect feedback, e.g. two way system to track result of signposting
14 Thanks for
the Petunias, A guide to developing and commissioning non-traditional providers to support the self-management of people with long term conditions http://personcentredcare.health.org.uk/sites/default/files/resources/thanks_for_the_petunias__a_guide_to_developing_and_commissioning_non-traditional_providers_to_ssm_for_people_with_ltcs.pdf
11
Resources to support plans The CARE (Consultation and Relational Empathy) measure is a patient-rated measure of the clinical encounter. An accompanying CARE Approach manual has been developed to help practitioners reflect on empathy and to practice, maintain and improve their communication skills. Both the CARE Measure and CARE Approach can be used by individuals, groups or organisations, and is available free of charge. http://www.gla.ac.uk/researchinstitutes/healthwellbeing/research/generalpractice/careapproa ch/ Measuring what really matters, Towards a coherent measurement system to support personcentred care, describes the principles of person-centred care and the activities that a personcentred system should undertake in different contexts. http://www.health.org.uk/publications/measuring-what-really-matters/ Asset-Based Community Development (ABCD) North Western University, USA. Asset mapping tools: http://www.abcdinstitute.org/toolkit/ The ALISS asset mapping pack suggests ways to capture and organise knowledge about local assets http://www.alliance-scotland.org.uk/what-we-do/projects/a-local-information-systemfor-scotland-aliss/aliss-resources/ Social Mirror, Royal Society of Art - Social Mirror is a tablet application to measure, visualise, and see the potential for change in online and offline networks. http://www.thersa.org/action-research-centre/community-and-public-services/connectedcommunities/social-mirror Brighter Futures Together – factsheet -how to map local assets http://www.brighterfuturestogether.co.uk/brighter-futures-together-toolkit/map-assets-inyour-community/ The Silver Dreams Fund is the first of the Big Lottery Fund’s dedicated investments in older people in England, in association with the Daily Mail. The Silver Dreams blog has examples of funded projects: http://silverdreamsblog.wordpress.com/ Newcastle Social Prescribing Project. NHS Newcastle West CCG project to embed a single, integrated process of ‘social prescribing’ into healthcare pathways for people with long-term conditions. Aims included embedding social prescribing in GP practices, developing effective monitoring and evaluation systems and supporting the rollout of linkworkers. http://www.healthworksnewcastle.org.uk/wp-content/plugins/downloadsmanager/upload/Social%20Prescribing%20Evaluation%20Report%20August%202013%20Fina l.pdf UK Men’s Sheds Association
12
The Men’s Sheds movement began in Australia when men realised they could come together around practical tasks on a regular basis, particularly if they had a designated place or workshop where tools and work in progress could be stored. The Shed concept was first realised in England by Age Concern Cheshire at Hartford in 2009, about the same time as the first Shed in Ireland. Now there are over 80 Sheds open in the UK, with many others being planned. They vary from full-time projects with paid staff and occupying industrial premises to groups meeting in village halls and community centres for only a few hours a week. http://www.menssheds.org.uk/
The Links Project; Developing the Connections between general practices and communities A need for social signposting or additional support resources was identified in approximately one in five consultations in this 2012 study carried out among six Deep End GP practices (working in most deprived areas of Glasgow) http://www.scotland.gov.uk/Publications/2012/05/1043/0 The Links Worker Programme This programme aims to explore how primary care teams can support people to live well in their community. It is being developed as a response to knowledge that staff working in general practices are in a prime position to connect people to vital support, but lack time and find it difficult to access community-led services. Seven community links practitioners are now part of general practice teams working in the most deprived areas of Glasgow. http://www.alliance-scotland.org.uk/what-wedo/projects/linksworkerprogramme/ The Improving Links in Primary Care This project was a partnership between the Health and Social Care Alliance Scotland and Royal College of General Practitioners Scotland. A participating practice, Nairn Medical Group, and the local Citizens Advice Bureau (CAB), made a successful joint application to the Lottery Fund to fund a part time links worker with a room in the practice. The links worker, an CAB advisor, has valuable knowledge of older people’s issues, and can signpost people to local support, advise on fuel poverty, debt, accessing financial assistance, power of attorney, employment, housing, relationships, disabled pass for cars etc. http://www.alliance-scotland.org.uk/what-we-do/projects/improving-links-inprimary-care/ Dundee Healthy Living Initiative Dundee employs Social Prescribing Link Workers, through the Equally Well initiative. http://www.dundeehealth.co.uk/ Scottish Consortium for Learning Disabilities LAC National Development Project A national network of Local Area Coordinators employs over 80 staff who are located in 20 out of the 32 Local Authority areas. About 75% of the LACs are employed directly by the Local Authorities, with the rest based in third sector organisations. http://www.scld.org.uk/local-area-coordination Alzheimer Scotland Alzheimer’s Scotland funds an extensive network of support for people with dementia and their families across Scotland. Thirty-two Dementia Advisors support
13
individuals, families. The role involves signposting, community connecting and capacity building. http://dementiascotland.org/dementia-strategy/2012/getting-post-diagnosticsupport-right-for-people-with-dementia-the-five-pillars-model/ The Aberdeenshire Signposting Project The Aberdeenshire Signposting Project aims to link people to local organisations, services, clubs and societies in their community. The Project is responding to the growing numbers of older people at risk of social isolation and accepts referrals of people over the age of 55 years. http://www.signpostingproject.org.uk/index.html Enabling Health and Wellbeing among older people, capitalizing on resources in deprived areas through general practice This project developed a system through which general practices in deprived areas could identify older people in need and help them access resources and/or participate in activities known to help prevent or delay disablement and enhance wellbeing. http://www.gla.ac.uk/media/media_282275_en.pdf Campaign to End Loneliness – a toolkit for health and wellbeing boards http://campaigntoendloneliness.org/toolkit/why/ Everyone Counts: Planning for Patients in 2013/14 – 2018/2019 http://www.england.nhs.uk/wp-content/uploads/2013/12/5yr-strat-plann-guid.pdf NHS England, High quality care for all, now and for future generations; Resources for Clinical Commissioning Groups (CCGs) http://www.england.nhs.uk/resources/ Social Prescribing for mental health – a guide to commissioning and delivery http://www.centreforwelfarereform.org/uploads/attachment/339/social-prescribing-formental-health.pdf Thanks for the Petunias, A Guide to developing and commissioning non-traditional providers to support the self-management of people with long-term conditions http://personcentredcare.health.org.uk/sites/default/files/resources/thanks_for_the_petunias__a_guide_to_developing_and_commissioning_nontraditional_providers_to_ssm_for_people_with_ltcs.pdf Local Area Coordination, From Service Users to Citizens; An exploration of how local area coordination can support people to pursue their vision for a good life, build stronger communities and help reform care services in England and Wales; Ralph Broad (2012) http://www.scld.org.uk/local-area-co-ordination The social and economic impact of the Rotherham Social Prescribing Project http://www.varotherham.org.uk/social-prescribing-service/\ Data from general practices in England http://fingertips.phe.org.uk/profile/general-practice Evaluation of Dundee Equally Well Sources of Support: Social Prescribing in Maryfield; Lynne Friedli (2012)
14
http://www.dundeepartnership.co.uk/sites/default/files/Social%20prescribing%20evaluation% 20report.pdf Quantitative and qualitative evaluation measures are included in the following Scottish Government reports: o
The Links Project 2012 http://www.scotland.gov.uk/ LinksReport
o
Improving Links in Primary Care http://www.alliance-scotland.org.uk/what-wedo/projects/improving-links-in-primary-care/
15
References 1.
Redefining Consultations: Changing Relationships at the Heart of Health, Martha Hampson with Katherine Langford and Peter Baeck http://www.nesta.org.uk/sites/default/files/redefining_consultations.pdf
2.
“Ageing is not a policy problem to be solved: Coming Of Age, Louise Bazalgette John Holden Philip Tew Nick Hubble Jago Morrison www.demos.co.uk
3.
Making our health and care systems fit for an ageing population; David Oliver, Catherine Foot, Richard Humphries Kings Fund (2014) http://www.kingsfund.org.uk/publications/making-our-health-and-care-systems-fitageing-population
4.
Isolation: The emerging crisis for older men; Brian Beach and Sally-Marie Bamford, Independent Age and the International Longevity Centre UK (ILC-UK), 2013 http://www.independentage.org/media/828364/isolation-the-emerging-crisis-for-oldermen-report.pdf
5.
The Public Health Outcome Framework, 1.18ii - Loneliness and Isolation in adult carers http://www.phoutcomes.info/public-health-outcomesframework#gid/1000041/pat/6/ati/102/page/3/par/E12000007/are/E09000002
6.
Improving Later Life. Understanding the Oldest Old, Age UK, 2013 http://www.ageuk.org.uk/Documents/EN-GB/Forprofessionals/Research/Improving%20Later%20Life%202%20WEB.pdf?dtrk=true
7.
Preventing loneliness and social isolation in older people; Emma Collins IRISS Insights No 25 (2014) http://www.iriss.org.uk/resources/preventing-loneliness-and-social-isolationolder-people
8.
Fair Society, Healthy Lives; The Marmot Review. Strategic Review of Health Inequalities in England post 2010 http://www.ucl.ac.uk/whitehallII/pdf/FairSocietyHealthyLives.pdf
9.
The Darzi Report, High Quality care for all. The NHS Next Stage Review Final Report (Department of Health 2008) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/228836/ 7432.pdf
16
