Social prescribing for mental health
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What is next for social prescribing in Scotland?
Please note transcriptions are auto-generated so may feature mistakes.
[00:00:00] Professor Sarah Skerratt: Good afternoon and welcome to the RSE’s Curious program. And it’s the third year that we’re delighted to run this program from the Royal Society of Edinburgh,
where our passion and our mission is knowledge made useful. The Curious program runs until the 22nd of August with events offering insights from some of the world’s leading experts across the four key themes of health and wellbeing.
Innovation and invention, our planet, and Covid-19 this particular event, as you know, is on social prescribing. And this comes as part of the program of work that we delivered through the post COVID futures commission. So I’d now like to introduce you to the two co-chairs of today’s event. Ben Lejac who’s policy officer at Supporting Mind, Scotland who carried out the research for the report into social prescribing for the Royal Society of Edinburgh and Theresa Shearer.
Who’s the group chief executive officer. For the Enable Group. So without further ado and looking forward to a really exciting event with a really expert panel I’d like to pass on to Ben Lejac and Theresa Shearer over to you, Ben first. Thank you.
[00:01:21] Benedict Lejac: Thank you very much, Sarah. And thank you all so much for being here today.
It’s really thrilling to be part of this session with the Royal Society. And I’m really looking forward to hearing the discussion and the actions that come next. To get things started, social prescribing is likely a term that you’ve heard somewhere. As an idea, it’s become more and more popular as a, as a, as a term used to describe direction within policy, within academia, within primary health care, within the charity sector and community organizations.
But what, what does it refer to? What does it mean? Well during the research for the, for the RSE’s from origins to opportunities report on social prescribing released earlier this year We found that there were two definitions related definitions. The first of these is one that you’re likely most familiar with.
We refer to it in the study as the specific definition or the, or the traditional definition. And in this definition, social prescribing refers to a journey where say I as an individual access a health service, a primary health care service, for example, a GP, very commonly a GP. And from that accessing a GP and refers to a community organization or a nonmedical opportunity within my community that is considered to be appropriate my needs and my concerns very often our link worker is, is the, provides the link between that health service and the community. Someone whose role is dedicated to making that connection. However, we found a second definition as well, which was much broader than that. We’re much more expansive where a lot of the people involved in offering community support.
Told us that healthcare can play lots of different roles, but there are lots of different ways of people accessing those community nonclinical, nonmedical forms of support. GP’s aren’t necessarily the first point of contact. They might be involved in the process, but it might be another healthcare worker.
It could be another community organization. It could even be someone in the A community organization, a friend, a family member. And so social prescribing from that point of view could be any means of connecting someone with a nonclinical form of support that is appropriate to that person’s needs.
So there we have two definitions, a specific traditional. And abroad expensive one, but both of them are about connecting people to the support they need. I’m really looking forward to the discussion. We have a really fantastic panel today and to introduce them, I’d like to pass over to Theresa.
[00:03:45] Theresa Shearer: Thank you very much, Ben. And thank you for the opportunity to introduce the speakers. And also just for a couple of minutes to perhaps explain why I have our particular interest in social prescribing. So I’m delighted. I think we have almost a hundred participants on the call today. So I’m, I’m told from Sarah from the RSE.
That is excellent. We should be very pleased at the interest in social prescribing. So, so thank you for that Sarah. And I think that’s very timely, so we should be pleased with the interest. And why am I interested? Well two reasons really: I worked for one of the largest health and social care organizations in Scotland.
Every day, we support thousands of people in the community to meet their personal self, directed, human rights outcomes, but often one of our biggest jobs and one of our biggest roles is to ensure that people don’t. Necessarily have statutory services as the default, and to help really work with individuals so that they can access those things that are available to them in the community that many of us take for granted.
So, so I am very interested from a personal professional perspective, but actually as I think I described in the inclusive working group. That for me, social prescribing is not just what happens in the GP situation or in a medical situation, but actually it’s what happens on the front line of social care everyday, but our front line staff and our teams all across the country are supporting people to do exactly as Ben described and to look at alternatives, to clinical, medical or statutory responses to things often.
Might be better served by more community-based outcomes so, so that’s the first reason for my interest. I do have ever have a second reason and I think I will go into detail of today’s GERS (Government Expenditure and Revenue Scotland) report but I’m sure everyone has seen it, but in terms of working in health and social care, you cannot work in this field and not be acutely aware of some of the issues.
In terms of the fiscal environment in which we operate in. So we know today in school, then there is almost 13 billion pounds spent health and social care. We know that 3 billion of that is split out towards care, but the majority of that spend and that income is within a clinical position and within a clinical setting.
Even before the pandemic those budgets were under excruciating difficult, difficult, difficult situations. We understand that in order to just keep going our previous health cabinet secretary identified that we might need an additional 6 billion pounds that was identified pre-pandemic in the medium term health and social care financial forecasts that were done by our government.
Post a pandemic. We know that that looks even more difficult for all of us involved in health and social care. So I’m particularly interested in social prescribing as potentially a way to look at how we support the changes within our demographics in Scotland, how we support individuals to have the best outcomes and to have the best lives they can and how we take some of that spend, which is often.
Focused on clinical and medical settings and actually ensure that we are making the most of all of our community-based assets. So I’m really looking forward to today. I’m really looking forward to our expert speakers. So without further ado, just a few quick intros in our speakers list, I’ll start with CLare Cook, currently a regional manager for SPRING Social Prescribing. She has worked in this field for over 15 years. The thing that I was most taken with Clare in your biography in particular was this idea that the social model of health is your raison d’etre in terms of your professional work and that idea of trying to reduce health inequalities by looking at a social model, as opposed to a medical model.
So if we can start with our first speaker today, which is Clare Cook, I’ll hand over you to Clare to see say a few words. Thank you.
[00:08:01] Clare Cook: Thanks for that to Theresa. So very briefly, because I know I’m short in time and this afternoon, thank you so much for asking me along, I really appreciate it so just a few key points I wanted to raise this afternoon and I’m keen to get questions as well.
So as Theresa said, I’m the regional manager for SPRING, Social Prescribing, which is a national partnership between Scotland and Northern Ireland. So we’ve been on for three years now, here in Scotland, we have eight community organizations that are part of SPRING and really the unique aspect to us as that we tell them a social prescriber, but they are essentially, a link worker, there’s much terminology out there, but we use the term social prescribers.
They are hosted within the community led health organizations. So they employ a social prescriber. These organizations organizations are rooted within the heart of their communities. They are trusted that highly professional and the community target hardest to reach individuals in their community.
So for us, that’s a massive benefit. I welcome the research. That’s just been carried out and I think there’s a lot of similarities to what we found over three years as well. So we have an external evaluation. We demonstrated the impact that SPRING has on people, on communities and on health care. So there are so many similarities.
One of the biggest things I would see as that. We are looking at investment. So this is about investment and to community led health organizations that run activities and social prescribing, how do people get involved? So that’s a big thing for us, we really need investment, so that social prescribing can run as best as it can be.
And the other thing I wanted to mention as an light of the pandemic previously, we were receiving referrals from GPs and primary care. Now, obviously the pandemic came along and everyone had to change their way of working. So we amended our referral route, so we now include pharmacists. We include housing associations, social work, education as well.
So when Ben was talking about the traditional route, we’ve actually transitioned into to the other route as well. So I think that’s working with communities it’s listening to people on the ground, about how we can be work and in light of this pandemic, so we’ve changed as a way of working as well. And lastly, I just wanted to mention, last year I established a Scottish social prescribing network.
And again, this was in light of the pandemic. And what we did was I contacted people that I have came across in this role and just said, let’s meet up and let’s discuss, how have your services changed and in light of the pandemic? So we’ve done that as a group, we started off with about 18 of us and we met regularly, and I’m really pleased to say that its grown and and developed.
And I, now you have a steering group that works alongside me and we are growing and developing this network as we go forward, we are just about to launch a website. On that website, there will be a membership page and anyone and everyone who’s interested in social prescribing, link working, community navigating and whatever the term is, please get involved.
So we’ll send the details as maybe you’re ready to launch that. So that’s a real exciting piece of our work. I’m really proud to be leading on that in Scotland. And I think that it. that’s the main things I’m really keen to get questions later on. So thanks.
[00:11:31] Theresa Shearer: Thank you very much for that introduction, Clare.
And I think that was really useful to give everybody an insight into social prescribing. So without further ado, we’re going to hear from Cameron MacFarlane. Now Cameron is one is Scotland’s leading advocates. He has worked up the sharp end of social prescribing for many, many years now. You have indeed worked as a links practitioner yourself at the front line. And so have huge experience of what that’s like. But what we’re really interested in today is beyond that experience at the front line, you’ve also got a kind of policy prism within which you’re looking at things particularly given your role as a community engagement manager.
With the alliance Programme, ALLIS, so a local information system for Scotland. So we’re really looking forward to hearing from your Cameron and to hearing some of your insights. So I will hand it over to you. Welcome.
[00:12:26] Cameron MacFarlane: Thanks very much Theresa and thanks for having me on as part of the session today. So look it looks to be really interesting.
Yeah, so I’ll just, I’ll give a bit about going to the ALLIS program and mainly in terms of what we do the purpose and the aims behind the program and how that links in with them, social prescribing or signposted more generally. So are we not involved in actually doing the social prescribing as such, although, as you mentioned previously, and another role was links worker, so I do have experience of actually doing that kind of links worker role.
And during that time did use ALLIS systems to support that work. But so currently my role is about working with communities, including connect groups, organization services, citizens, anybody living, or working within communities to help them to find on, to share information about the community assets, different supports, services, groups, activities that exist, in those local areas.
So Just to kind of explain a bit of background about it. It was it was co-produced originally it was co-produced by people who have lived the experience of, living with a long condition who are disabled, providing unpaid care, as well as with health and social care professionals. And it really can focus that on three questions.
So firstly, what is it that keeps you well? And in terms of the answers to that, you can imagine that for people, it was really broad in terms of the different supports and services out there that help people in terms of their health and wellbeing. So that includes formal services and statutory services, but for a lot of people it was very much about those kind of informal activities, community assets exist and local areas as well, and things which are vital in lots of different ways for health and wellbeing, so groups, community choir, walking groups, and anything that can help people either, whether in terms of social connection, physical activity, or just being able to kind of get involved in engaging and doing meaningful or enjoyable activity, connecting with other members of their communities as well.
I mean that again, that’s really broad in terms of the range of stuff out there. People did say, that is is quite often more difficult, or challenging to find the information that they need about that stuff. So even though there’s so much out there so many great things exist is often quite difficult for people to find information either because.
It’s just not published as maybe a leaflet or notice board somewhere and where you might have to rely on word of mouth to find out about it. Just happen to speak to the right person, or even when it is published. Quite often, things are existed in silos. You get various information silos that information is duplicated across.
It’s not always up-to-date or as accurate as it could be. You almost kind of need to know what you’re looking for and where to go to get it, which is not, it’s a bit back to front sometimes because I actually, maybe people don’t know exactly what they’re looking for, but when they find it and then they realize. Really what people wanted to have to have one kind of view of all of this stuff and information about all the different stuff that was out there.
And to give it, to get that from various places that it’s familiar or accessible for them. So the different channels, the different groups they would go to, whether that’s going online, potentially themselves to look on and so ALISS exists as a website and people can go into ALISS, look for information themselves, and some people might do that.
Some people make with other websites. So one of the important things for us is to make sure that the information within ALISS is available through other systems, our channels as well, but also people might go and speak to either professional or family and friends in terms of social prescribing or sign postings.
So it’s about having that information available through the routes, whether it’s speaking to somebody or access themselves Lastly, just, I guess, think an important thing to say as well is that all of that information is essentially crowdsourced. Added together and maintained by communities. And so that includes organizations themselves, or it includes professionals, but again can also include citizens, people involved in local community mapping activities.
And, it enables people to share what they know about what they’ve found useful as well. So as a kind of bottom up approach and through the ALISS program, we’ve worked with a variety of different people, including people like GPs, primary care teams, but also again, I think Clare mentioned community pharmacists, for instance, and we’ve had conversations for instance, with organizations like Scottish Fire and Rescue who maybe are looking to do sign posting as part of their home fire safety checks.
So a whole range of different groups, organizations, and not always people who would necessarily even see themselves. Being social prescribers are doing social prescribing, but are still involved in that sort of activity in terms of helping connect and find and access information about things that helps people to stay well.
So similarly, I’ll stop there for now, but looking forward to questions.
[00:17:16] Theresa Shearer: So, thank you very much Cameron for that run through all the great work that you’ve been doing. Just before I introduce our next speaker Hugh Asher, just a couple of things you will see in the chat box. sign posts to some information.
If people are intereted in understanding more around social prescribing in the next couple of minutes, we’ll have a couple of sign posts to, and two other resources. One from public health, Scotland. Who have done some work at case studies of social prescribing, which I think people might find very useful as a first entry into getting some general information.
And then the second really important piece of reporting and the evidence work was conducted by Iris in 2020. So again, we’ll have a link to the Iris evaluation of social prescribing in Scotland. So we can see a lot of work being done around social prescribing and a lot of interest around how it might work.
I’m always really interested, we have a saying at Enable here, when we say demonstrate by doing, and I’m delighted to have you on the panel today to talk exactly about how you have. Demonstrated social prescribing with you to work that you’re doing. So Hugh has worked for over 20 years with a wide range of people and citizens, people with acquired brain injuries, people who are experiencing mental health issues, people with learning disabilities, autism, for example, and in 2020, you establish something which I find fascinating coming from my background.
A social croft, which I think is described, as a little bit like a care farm and using natural resources to enhance mental wellbeing and good personal outcomes for individuals. So here we are looking forward to hearing from you around how you have demonstrated by doing your version of social scraping in Darach Social Croft.
And I hope I pronounced that properly for you Hugh.
[00:19:10] Dr Hugh Asher: Hi. So, yeah, thanks a lot for inviting me. Yeah. My name is Hugh and I’m one of two people who started Darach Social Croft. About two years ago, we’re based in on the Ardnamurchan Peninsula. And we operate really as a, as a social enterprise. So a social croft as Theresa, I said, is really like a care farm, it’s just a, a Scottish version. And we primarily use nature and the sort of natural resources that we’ve got on and around the croft for therapeutic and beneficial purposes. So some of what we offer is working with the animals. Caring, caring for them. Yeah. Well welfare and things.
And the benefits that people get out of this just stroking animals and interacting with them can have really good effects on boosting mental health. Yeah, quite a few of the people who come to the Social Croft are used to being receivers of care. And so even if it’s just for small, while being in a position where you can provide care, to another sentient being can be rarely important.
So we offer sort of animals and agriculture, I call it. So we do some multicultural stuff too. I’m a great believer in. nature mindfulness and things. And, and that, you know, if we engage with nature through our various senses, we build nature connection, then that this is really beneficial. So primarily we, we target our services at people experiencing poor mental health people with learning disabilities, people with autism.
And currently we get some referrals from cam some from social work, a few from GPs, youth justice. We have a few self-referrals in terms of how we provide our services. We have a couple of people who pay. Each week through their personal budgets, we’ve previously had some grant funding and we’ve received some more recently that will help us to do this.
As a social enterprise, we also have some sort of diversification activities. So we offer goat walk. I’m a forest bathing guide. So we, we, we do, you know, make the most of the tourist money round here rarely to supplement things. But I do think that social prescribing would be something that would enable us to.
Offer really good service, really good value for money. And one of the great things from my perspective is as anyone who’s applied for grants before you kind of have to balance what it’s going to cost you in time to apply for the grant to what you’ll get. So the big benefits that I think of, of both social crofting and really social prescribing, more widely is the potential to offer alternatives to commercial.
Conventional approaches. So one of my other jobs is I’m a volunteer manager for a small mental health charity, and we have a helpline and one of the things I hear quite often is, is people saying that they’d been to the GP. And it’s medication or nothing is what they’re offered or sometimes they get talking therapies, but, but it’s not always what they want.
And I think that social prescribing can provide some really innovative stuff. One of the big things that, that. Care farming. Is that in terms of mental health supports, engaging men with support is really, really difficult. And one of the advantages of sort of a care farming or social crofting approach is we kind of have a leave your diagnosis at the gate. idea. You know, you can come in. If you want to talk about what’s going on, you can talk about it. And if you don’t, you don’t have to. But through, throughout my professional career, I’ve found that men in particular talk much better if you’re not looking at them. So rather than looking at each other, if you’re looking at, you know, checking the goats, hooves, you know, you’re checking the health of the cows.
Then people tend to relax more and they talk more. We, we talk a lot about the, the amount of time that GPs spend dealing with almost non non health conditions. So things around social isolation, social issues, and I think particularly in social and in rural areas you know, social isolation is big.
And so I think innovate innovation is a really big thing. I, I truly believe that social prescribing can be cost-effective. The social, the Scottish parliaments report. looked in and suggested that social prescribing should be seen as an investment and not a cost, which fits in really well with what Clare was saying about investment.
And also, I think there’s a big opportunity to, to provide early intervention and a focus on preventing deterioration, even if it’s just like a holding pattern until people can see, you know, mental health professionals or other health professionals. And this change in focus a bit like Cameron was saying to you know, look at what keeps people well, rather than necessarily just responding to the problems after they arise.
So again, there’s government backing to this review and adult social care suggested prevention was, was the was the thing. I’m a big believer in what are called salutogenic approaches to health promotion. So these are approaches that focus on the factors that support good health. They support wellbeing rather than just waiting until people are unwell.
So finally, my important feelings about. Social prescribing that there shouldn’t be an assumption that people don’t access community resources because they don’t know that they’ve that and that they need signposting. We come across quite a lot of people who have social anxiety, they have a lack of confidence or, you know, maybe they have autism and struggled to engage easily with, with what’s available in the community.
Yeah. For example, I, when I was working on, on our helpline, I talked to somebody who’d been to the GP and the GP had said, you know, we have lots of Hills go and join a walking group, but it was somebody with the kind of social anxiety that means that they can’t do that. So I think social prescribing has got a lot. A lot to offer in terms of bridging gaps and supporting transitions to community resources, as well as just signposting. So that’s that’s me and my thoughts on social prescribing.
[00:25:47] Theresa Shearer: Thank you very much Hugh. That was so interesting. And it’s just about time to hand over to Ben and Ben is going to give us an update on the Royal Society of Edinburgh’s published report on social prescribing in Scotland in 2021 on what we can expect for the future, but just before we do.
And I understand that technologies is not great for everyone, and I think we’re all a bit tired of it now. But before Ben speaks, if I can ask people to think about questions that they might want to ask your speakers today and I’ll use the prerogative of being the co-chair by suggesting I have lots of questions that I won’t ask as co-chair, but around funding.
I think there’s lots of interesting questions around funding, around regulation and particular issue. Hugh, I was struck by some of the things you talked about around some of the people that you’re working with, and typically we might be in a heavily regulated health and care enviornment. So, so where does regulation, come into it and what is next for social prescribing.
If we think about what’s happening to our environment with the closure of leisure centers, with the closure of clubs, with the fact that communities are under pressure. So those are the kind of themes I think the audience may wish to explore. So if I can encourage you to get your questions into the Q&A box And just, before we do that, I will now hand over to Ben to give us an update on his report for the RSE in Scotland.
[00:27:13] Benedict Lejac: Thank you so much, Theresa. And thank you to Clare, Cameron and Hugh as well. It’s really, really great to have you part of the conversation today. So the, the, from origins to opportunities report on social prescribing was published in April. And we’re specifically looking at how social prescribing as you’ve just described by our panel can contribute to a citizen centered recovery for Scotland’s public services, whether statutory or voluntary that study looked at case studies of social prescribing, contemporary and historic and within Scotland. And more broadly are with Scotland. It also Employed a survey to understand the views of people, both delivering and accessing support through social prescribing arrangements.
We conducted interviews again with people, both delivering social prescribing support at the community and statutory levels. And also with people who had personal experience of accessing support through those arrangements And I’d like to talk about the recommendations that that report makes.
Cause I think that’s a great place to start for taking the, the conversation forward today. So the first recommendation the report makes is increasing the awareness, improving the awareness of social prescribing. And this, this ties in really neatly to what Cameron was saying about how difficult accessing appropriate information can be that we found in the study that you.
Areas of Scotland that had longstanding and well-established social prescribing arrangements active in the area. Many people obviously where not entirely aware of those arrangements but that, that sort of patchy awareness extended all the way up into primary health care. One study from, from 2019 found that 7% of medical students were aware of what social prescribing.
But tellingly off those 7%, 98% felt that it would be an important part of their practice in the future. So there is clearly a lot to do for improving awareness of social prescribing at every level from, from public awareness all the way up through, the third sector and community organizations and into the public sector.
The second recommendation that we make in the report is recognizing the diversity of social prescribing. You’ve just heard from our three panelists an enormous diversity of the ways that social prescribing and connecting people to support in that communities can happen. The different reasons it can happen, the different places it can happen.
That even though on the one hand, there has been a move towards a national rollout, social prescribing in Scotland. There is there’s huge appetite for that within existing social prescribing arrangements and within some policy-making circles as well. But what we heard from community organizations and from people with personal experience was we don’t want it to be one size fits all.
We like that there are different arrangements that suit my needs in different areas in different ways. If, if this is going to be a national phenomenon, a national rollout, we want different forms of social prescribing to be acknowledged and recognized and have those differences safeguarded and protected.
The third recommendation was to resource all parts of the social prescribing infrastructure. We found that resourcing came up time and again, as a concern and as a barrier for delivering social prescribing. And you’ve heard that from, from our speakers today that on the one hand primary health care.
GPs were expected to take up that burden in areas without link worker infrastructure, but community organizations and community led social prescribing arrangements. We’re often expected to take off primary services without without that being matched by an increase in resources for that work . So resources is a, is a huge part of the discussion going forward.
And the last recommendation is improving accessibility. That the, the conventional understanding of social prescribing as taking place in a medical setting. That is an important part of the process, but it’s not the whole part. And we found lots of individuals and, and social prescribing arrangements that emphasize the need for, for points of access into social prescribing out with medical settings.
Clare and Cameron have both talked about how opening different sources of referrals can help contribute to that. And a lot of learning from Covid-19 has taken place in terms of considering online referral community referral alternate primary health care referral sources. So those four recommendations we would really like to see as part of the conversation going forward from the, from the report.
But I’m really interested to hear your questions and see how we can take some of this forward.
[00:31:28] Theresa Shearer: Okay, thank you very much, Ben. And as I previously said, for those interested, the report is sign posted in the chat, but some questions have come in already. So if I can just go to our speakers with the first couple of that’s okay
One that I think is really interesting, which speaks to the culture of social prescribing. Ideas from the panel on how we get GP buy-in for social prescribing. Because you identified that as potential barrier, Ben. So any ideas from Cameron, Hugh, and I’ll start with you Clare on how we get GP buy-in social prescribing.
[00:32:07] Clare Cook: Yes. So as I previously said SPRING was set up to alleviate pressures on GPs and primary care. What we’re seeing, and I know that the community, like what the program does that as well, and lots of other services in Scotland does that. So for us its tricky, I’m not going to lie. It’s been difficult, simple and different areas of the area’s different.
Every GP practice works differently. One of the benefits that we have had is that, we have an online digital platform where referals come and directly from the GP straight into our organizations. So that’s called elemental software. So within that, the GP to refers staight away. It’s a really simple process, it takes about two minutes, but the GP needs to buy-in into doing that.
And that’s the thing. So we do take paper referals as well, but within that everything is recorded on that system. So the GP could go in and say. For example, Mrs Bing has been picked up by one of these organizations, and I can see that she’s done all types of support with that. So the GP can physically see what’s happening with their clients.
So that’s a benefit. The pandemic has completely changed the way that we work people when go into the GP practice, hence why we had to open up a referral routes. So for us, it’s been challenging in some areas. The one, the one last thing I will say. As part the Scottish network I have set up. We have the medical students involved.
And so as part of the universities, they have a social prescribing champion scheme. So we have thr lead champion involved in our steering groups. So that’s a real benefit because this is about shaping the future medical doctors and GPs of the younger generation to buy-in into social prescribing as well.
[00:33:52] Theresa Shearer: Okay.
Great, Hugh, Cameron from your perspective?
[00:33:54] Dr Hugh Asher: I think part of it is going to be demonstrating effectiveness. And also I talked a bit about, you know, bridging the gaps between GP practices and sort of public accessible community resources. And I think one of the things, one of the problems that we face. When we are offering a service, which is.
Functionally therapeutic, but as, as you kind of said, not exactly regulated again just makes things slightly, slightly more difficult. We, we have a code of practice as, as a member of an umbrella organization of care farms. So it’s, it’s not completely unregulated, but even in terms of. Work I’ve done for mental health charities and trying to engage with GPs.
They can quite often be reticent to be seen, to be sort of referring or signposting to non NHS, vetted organizations and things. So I think it’s, it’s a, it’s a slow process. It will involve. Demonstrating effectiveness. And I, and I think, you know, at some point that needs to be all, hopefully be some kind of evaluation and the evaluation will need to be outcome focused rather than just our output focus.
So, you know, look looking at the benefits rather than just looking at the numbers.
[00:35:36] Theresa Shearer: Okay Hugh. That’s great. And I’m going to come back to you on the question or ethicacy and evidence because we have a really great question on that from Ian Patterson, but Cameron, just from your experience as a link worker orn the ground in GP practices, what can be done to get more buy-in more quickly, I would suggest for GPs potentially.
[00:35:57] Cameron MacFarlane: Yeah. I mean, I think would agree with everything that Claire and Hugh has said already. I think, definitely. It will also be a bit mixed in terms of lots of different GP practices, lots of different individual GPs who maybe some are more keen to buy-in and some less keen. I think overall based on my experience, they are keen on the idea, I suppose it’s maybe overcoming some of the barriers to that.
So I suppose there’s two sides to it. So one is about buying into the kind of concept, in terms of social prescribing. But then. I guess there’s there’s challenges for GPs just practically in terms of themselves who are actually doing the sign posting or the social prescribing. Obviously we know like time is really limited for GP consultations and it’s really difficult for a GP, even if they are really bought in and what to do this, it’s really difficult to have the time to spend with somebody to have a conversation.
That lasts beyond 10 minutes a lot of the time. So to be able to kind of develop that kind of proper kind of shared mutual, understanding those goals and ambitions and to talk through it and link peoplea and to know what’s out there. That’s all kind of really difficult for GPS in terms of just their time.
So I don’t think it’s necessarily a don’t want to do it. It’s about how that is kind of possible within the constraints. But then obviously, then there’s the kind of link more. It’s going to connect with your side of things. So I think most GPs would be keen on the idea of having a links worker or somebody in that sort of role they could be refer onto, so it’s not necessarily that they’re not bought into the idea of it, but how it’s done or those kind of barriers to overcome.
But yeah, I think again as Hugh and Clare mentioned, obviously then yeah. Maybe challenges around the scope in terms of some of the things that GPs may or may not be always comfortable with referred it on to. So maybe more limited in terms of some of the, some of the things that might be likely to, to refer onto.
But again, I think it is about demonstrating the kinda impact and the benefits of, of some of these things. And like we know from like stories and learning that actually. If you, if GPs are able to see the difference that some of these kind of social and community assets can make people then and if they can develop that kind of trust and awareness of them, I think that’s quite key as well as developing the relationships.
But it’s not just about knowin that something exists. But if you have a contact, you have a relationship with that group or that organization, then probably, we’re likely to refer it on because you kind of knew what to expect. So I think there’s a lot to it
[00:38:43] Professor Sarah Skerratt: A Lot of getting points there, Cameron, and I think one of the things that was really important around Ben’s research was that. Certainly the numbers that fascinated me the most was between 25% and 50% of GP appointments were actually for non-medical issues.
So GPs. Find themselves that much of their time spent dealing with issues that would be far better supported in some community based settings. Or so perhaps we are starting to see a bit of a change of the tide with that recognition, but both you and Hugh have talked about evidence. And we had a brilliant question from Kieren Patterson about using technology and systems to help gather that evidence.
And I wonder, Clare, you talk a little bit about systems in the discussion earlier, what is your experience with using technology to help bring together some of that evidence that we could use in trying to help persuade GPs to say more about social prescribing?
[00:39:39] Clare Cook: If so, for us, that’s, that’s a vital part of what we do like I say we use elemental, software, so that’s our digital platforms, so the referrals come in, we also.
Our monitoring tools that we use, it’s all about evidence for us because we had funded initiative so we need to prove our worth. We need to proof this model works. And why is it definitely how’s it working? So the monitoring tools that we use as the short way in webs and the wellbeing status.
Part of the outcomes. So all of that is on elemental platform. So I could see the difference its made now, not every journey is going to be linear. As we know with mental health, it goes up and down and people dip in and out, and that’s okay. But all of that is recording on the system and like I say.
With GPs or whoever has referred. They can go on and see what difference has this made. However, another part of it is our social prescribers will directly feedback to who’s referred them, and say, here’s what your patients have benefited. And then here’s what we’ve done. So there’s, there’s quite a few others quite there’s different elements to use them digital.
But for us, it’s been a benefit.
[00:40:46] Theresa Shearer: Okay, great. Now we are very fortunate within, or participants today we actually have a former health minister Andy Kerr. And Andy himself has asked a really interesting question. And Cameron. I think this question probably goes to you, how do we persuade people that we have to invest our money, not bricks and mortars, but actually the things that you already see in the community.
Because we know that people get very, very attached or new to local hospitals, to local GP centers and to the things that are tangible to them. Any thoughts on that? And how do we get some of that money redirected without upsetting the apple cart in terms of the people of Scotland and that kind of understanding of what we’re trying to achieve.
[00:41:36] Cameron MacFarlane: And yeah, I mean, I guess part, part of it probably also can I just relate it to what we can talk in terms of demonstrating the impact and took evidence and the outcomes for people. Accessing this different type of support. So whether it is more kind of a constant of the, also again, those kind of stories.
And I suppose just having more of that lived experience in terms of people being able to explain and describe, what it, what it was, it was helpful for them and why. And I suppose that does kind of probably go to the heart of it. Well, the lived experience in coproduction and what people actually say is important to them, what matters to people.
So again, going back to the reason and that they can have focused on a lot of those activities because that’s the stuff that people said was important to them in terms of their health and wellbeing. And it’s not to say that those other things are not important, obviously they’re vitally important as well.
It’s just that. That having the kind of, I suppose, the bricks and mortar is not enough and of itself, but you also need the community assets. You need the connection and the relationships and all of that kind of stuff that can’t be provided by the health service or any other formal service necessarily.
So it’s not, there’s not necessarily one or the other, I wouldn’t say, but it’s about recognizing the value and the importance of what does existence in communities.
[00:43:03] Theresa Shearer: Okay. Great. Thank you. We’ve got lots of questions and we’ll certainly try and get through a couple more, but there’s one really speaks to my heart. And I’m going to ask this question of Hugh and Ben, I know you’re co-chairing, but I think from Support in Mind, this will interest you.
So an anonymous participant has asked what I think is probably the best question of the day, but I’m biased.Which is how you doing, make sure that voluntary organizations are not just put under more pressure to do more? With no additional funding. So I think a really interesting question that if we get GPs and all of those people involved to see the benefit of social prescribing and to start to utilize it more, how do we ensure that those voluntary organizations and small community-based organizations are being properly funded and resourced and able to carry out more works will benefit me.
So Ben, I’ll start with you.
[00:43:59] Benedict Lejac: Thanks Theresa, this is a very good question. And it’s one that, that came up time. And again, when we were consulting for them for the report I’m sure it’s something that all the panelists would have something to say about. I think firstly a big, a big part of this Is what Cameron was just talking about in terms of building connections.
I think building partnerships between all of the parts of any given social prescribing model, that’s not just about building statutory third sector relationships. That will be the case for some many social prescribing systems, but not, not for all of them. Building the partnerships between organizations.
We found that. That helped not only share available resources, but also maximize the ability to lobby, if you want for more resources or certainly mobilize for more resources. I think to a certain extent, the making sure that the pressure doesn’t fall entirely on community organizations is going to come back to that.
First recommendation of improving awareness that ultimately it is, it is going to take a big push to make it more known how much pressure and, how much resource commitment it takes to deliver the kind of, arrangements that social prescribing offers But I think on, on until, until we’re at that point where it is very publicly embedded, I think building those kinds of into, into organization and, and cross partnership relationships is really important way of alleviating pressure, maximizing funding. But I’d really love to love to hear from the rest of the panel on this in case
[00:45:29] Theresa Shearer: Hugh, I’m interested to bring you in next, because you talked about personal budgets and I’m a huge fan of personal budgets. Might that be one of the ways that individuals can, can almost buy their own community, social prescriptions in order that it’s very self directed.
[00:45:46] Dr Hugh Asher: Yeah. So I think that’s an, it’s an ideal way. So you, you, you it’s, it’s about the most person centered way to allow people to make choices and pay for the services that they want. I think within the social prescribing model, there is scoped for. Yeah. Contracts between community level organizations and GP practices to provide, you know, a certain amount of support over, over a given time.
I think one of the key things with social prescribing is going to be that the, the cost savings aren’t necessarily. And getting voluntary sector organizations to provide services that are free. And then, and then that way take financial burden off, off the NHS. I’ve got to say that in, in certain areas, certainly at Highland, there is at the moment a push towards trying to create a more level playing field that there’s recently been a well charities and community organizations with comparatively small turnovers can bid for three NHS contracts.
And the idea is to distribute contracts in a fair way across partnerships, across smaller organizations. But, but it’s still in many ways are a little out of reach of something like a small social enterprise, like we are, but I’m sure there will be a. There isn’t one way.
Of sorting this out, there will be multiple paths. And I think it’s about maybe pilots and seeing what, what kind of paths work. But, but all the social prescribing pilots that I’m familiar with have always come up ringing the bells as it were and saying, you know, this really is something that works.
[00:47:46] Theresa Shearer: Okay, thank you so much for that answer Hugh. And we have a number of questions that we simply won’t have time to get to today. So two very good questions from you. And I think what we may be able to do with the RSE is when we do a write up into the session.
Get to those questions and ask your panel is to answer them, but what we’re coming towards, the end of our session. Thanks Sarah. We’re coming to the end of our session and to what I think is probably the most important part of the session, we’ve left the best till last, Marion and Simon. So thank you for joining us.
And I’m very much looking forward to hearing about your personal perspective. But I’m, I’m going to ask Clare, who I know has a strong, personal relationship with you to introduce you to our panelists and really to hear from you, the experts on social prescribing and what you want to see from us as panelists today in order to help more people benefit from social prescribing.
So Clare over to you for the introduction.
[00:48:46] Clare Cook: Well, I’ll say it’s actually not me that has the relationship it’s actually Catherine and Becky, who are the social prescribers based that Shotts Getting Better Together. Those are the ones that have really been supporting Marion and Simon, and I’ve heard their story and it’s absolutely brilliant.
So I’m not going to take up any more time other than to say thank you for coming along again and take it away, let people know what the impact that SPRING has made on your life.
[00:49:09] Marion and Simon: Okay. Well, we first got involved and there was a welcome session at the SPRING hill club. Me and Simon went along to that. We then got referred to the the doctor referred us.
So we then became involved with the healthly living center, met Becky and Catherine. And right from the get go and Becky and Catherine have been supportive. Their personalities are brilliant. They always do. No question I’ve ever had of them was any problem.
I know I could pick the phone up now or text now and they would be able to help me.
But we first got involved with the coffee mornings and Simon is a celiac. But he went along and think, right, I’ll just get a cup of coffee. Cause he didn’t want to put anybody out. Becky had none of that. No straight out gluten-free bread, gluten-free biscuits. No, you’re here. You’re going to enjoy yourself whether you like or no laddy. So that was it. He absolutely loved going because he then felt part of something that then lead onto, Kirsty in the men shed. So, but then obviously we
had the Covid start and that’s when you notice things because you’re not in contact with these people anymore. So we started doing Zoom which I had never heard of.
I can barely work an iPhone, but I can get right on to a Zoom meeting. So we had, we did a book club. We did an art group, Simon did yoga online. We do the Friday night in. And we still do that now. Even though we can meet on a Tuesday, down at the healthy living we still do the Friday night in because not everybody can get there. And it’s just a wee blether and a wee catch up.
How is everybody doing?
We do the monthly bingo
I’ve started doing afternoon teas. We’ve been to the gym. We do the shopping at the health living centre,
and, before, before we got involved with this. Simon would be a home while I was at work. No he wouldn’t, he wouldn’t go out. He wasn’t one of these people who would strike up a conversation with people because he felt it doesn’t have any input. But now after, after being in contact with people, you’ve done the gardening as well. And now he’s got a whole network of people in the local community that he can interact with. And this is purely down to the passion and dedication of Becky and Catherine. There’s, there’s nothing else you can say. They are so passionate about making sure every person who’s been socially prescribed to them gets love.
Love is the word. Do you know what I mean? But yet they’re so dedicated to this, to this job and they’re brilliant at it. I can’t fault them in anyway.
[00:52:09] Theresa Shearer: Marion, Simon that is outstanding. And I think the quote of the session before I hand over to Ben to finalise today’s session is “all that they give you is love”. And actually it’s something a GP can never prescribe and it’s something we can never get from a clinic setting and actually, if you to say what’s so special about social prescribing, I think you’ve just summed it up beautifully Marion.
So thank you for that. We’re all going to take that away with us today. So, Ben, I don’t know how you follow that, but I’m glad that you that’s finishing up. So thank you, Marion. And thank you Simon. And I’ll hand over to Ben, just to finish up the session.
[00:52:50] Benedict Lejac: Theresa I don’t think I can follow up from that. That was, that was fantastic. Thank you so much, Marion and Simon, amazing to, to, to hear from you and I think no, no better. Way to show the impact that what we’ve been talking about can, can have I think this is, this has been a, a really fantastic all too short conversation. But as Theresa said we will hope to get any unanswered questions.
And make sure that, that we address them as best we can. This is a really exciting conversation to be having Scotland’s public services have never encountered a challenge like Covid-19 before. Having the fantastic panel that we’ve had today. Talk about the work that they’re already doing and having the questions that we’ve had shows that the conversation is starting to happen for how we make Scotland’s public services, more citizen centered and how best we can.
We can support them to, to recover from the pandemic and look forward to a more person centered. So thank you all so much for coming along today. It’s been an absolute pleasure to be here. And thank you hugely to Theresa on our panel as well. It’s been amazing to have you as part of the conversation.
[00:53:53] Professor Sarah Skerratt: Thank you all very much. And that concludes this part of the Curious event. As I mentioned at the beginning. This Curious festival goes on online until the 27th of this month. So please do look on the website, www dot RSE dash curious dot com and go and see what else there is. Of course it won’t be as good as this one, which was absolutely brilliant.
But please do go and have a mooch around and see what else might entice you. And we will thank you Hannah who has put the proper link in the chat? And as has been said so eloquently by Ben and Theresa, we will be following up on this and checking up on the unanswered questions. So thank you to all our panelists including the star act of Marion and Simon there at the end and to our two co-chairs Ben and Theresa for your time and to all the questions.
Okay. And to all of you who took part. Thank you very much and enjoy the rest of your day. Thanks, goodbye. Thank you.
[00:54:53] Benedict Lejac: Thank you so much. Bye
[00:54:54] Cameron MacFarlane: Bye.