#SocialPrescribingDay

The 14th March marked the first International #SocialPrescribingDay. The Social Prescribing Network said that anyone could get involved whether individual or community, university or general practice.

It was only a very small contribution, but I did two things. I created the following poster that was put up in GP surgeries locally.

 

Social Precibing Day Poster

and highlighting the value of friendship and the importance of community, I sent a bunch of daffodils to everyone in my street.

daffodils

I was also very grateful to receive the following t-shirts on #socialprescribingday, which I look forward to using to spread the good word in due course.

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Three Strands to my Social Prescribing Scheme Dream:

I have come to realise there are three strands to my social prescribing scheme dream. They are imbedded, intertwined and I can’t establish whether I need to focus on one (if so, which one!) or all three to achieve my goals, if they are even possible, particularly as an individual.

I started off 2019 applying for a job in Social Prescribing, because it was dangled in front of me. I got a flat rejection! I am now incredibly grateful for this, I did not have the knowledge or experience and it wasn’t specifically what I want to do. But, I still went for it, and I am human… It’s taken a good few bars or chocolate, or parkruns depending on whom I am speaking too, to process this and get back on the band wagon. That, and umpteen sickness bugs suffered by and gifted from the children (does anyone else think January and February should just be scrapped?) has meant I have been away longer than I had intended, but… Im back!

So these three strands. Do I need to define what I am trying to do? Elizabeth Gilbert, author of international best seller Eat, Pray, Love argues that its important to enable your creative mind to live, to try not to feel anguish and failure and to kill off ideas. Allow yourself to dream and believe.

Well, this might feel a bit too creative for my NHS background, but, she definitely has a point. I am enjoying perusing my ambitions and I am not sure where they will take me, but I am enjoying pursuing each and every avenue. Whilst social prescribing is definitely developing at a pace with wonderful successes such as the recent international #socialprescribingday on the 14th March, and commitments and priorities such as those outlined in the NHS long term plan and the GP partnership review,  I try and remind myself that my #socialprescribingschemedream does not need to happen overnight. Whilst I am learning, enjoying and feeling inspired there is a good enough justification to carry on.

What I have come to realise is that my interest within social prescribing does not fit directly in to the following pathway whereby a patient visits a GP and is referred to a link worker/community navigator.

social prescription pathway

I have the same aspirations and outcomes as this route. But I am more interested in utilising the social prescribing model to explore how health promotion is delivered universally, and what people have access to, to inspire and improve their health and wellbeing within a community.

I have come to realise I am more interested in public health and would like to focus on universal health, rather than individuals identified such as those with complexed needs seen by a link worker or community navigator and in receipt of a social prescription.

To this end, the 3 strands I am going to continue to explore are:

  • Social Prescribing and Health Visiting. I am passionate there is more to be utilised from the Specialist Community Public Health Nursing profession than is currently being pursued within Social Prescribing. The discourse between the University degree to become a SCPHN and the reality of the job is grand, but, the training aligns perfectly with social prescribing and I would love to see Health Visitors and School Nurses skills, qualities and experience captivated within and enriching the Social Prescribing offer.

 

  • GP surgeries and universal health promotion… waiting rooms! Its superb that the social prescription offer is now being taken seriously and we are reconsidering the social determinants of health rather than a purely medical model approach. But, I would like to see the waiting room utilised to promote health. I would like to explore how to inspire health and wellbeing from the moment you step into the building.

 

  • Taking strand 2 a bit further, the final area that interests me moves away from the NHS entirely and looks at how a community can embed better health and wellbeing within its highstreet. and having this endorsed by the health service. Avenues I would like to explore include regenerating the high street, community hubs, allotments, park runs, man sheds and community fridge, park runs, cookery demonstrations and intergenerational work.

 

I know these three bullet points could take a lifetime. They are ginormous and to return to the fist paragraph of this blog, I know I cannot achieve all three. This cannot be the goal. But, I wanted to get down on paper what I am interested in and why I will be chopping and changing around different avenues… At the moment I am considering all these possibilities in my ideas funnel!

 

 

The South East Social Prescribing Conference

Full of beans from the Kings Fund Social Prescribing: Coming of Age conference earlier this month, I set off excitedly to the South East’s Regional Social Prescribing conference, “Collaborating for growth”, funded by NHS England.

On arrival, I spent the first 10 minutes of ‘networking’, nervously sitting in the car! (Come’ on, don’t tell me you haven’t been there at some point!) I was trying to perfect my spiel, “who I am, why I am here”. I find conversations like this particularly tricky. Whilst others represent their place of work, I am here as an individual, someone passionate about social prescribing, but not yet quite sure which direction it is going to take me in. Most assume I want to be a link worker, perhaps because of my nursing background and the fact I am happy to volunteer my time. But I don’t want to be hands on in the delivery of social prescribing to individuals. I am getting more and more interested in delivery at a service level.

It is safe to say the ‘car park rehearsal time’ was worth it! As I entered the conference, Craig Lister, managing director of TCV’s Green Gym™, welcomed me and said good morning. I knew Craig from being the guest speaker on the previous evenings #SocialPrescribing @SocialPresHour. The power of social media hey! Craig introduced me to Nicky Saynor from Public Health England who was very encouraging and supported my presence at the conference as a “Social Prescribing Champion” and an ‘asset’. Much better than the ‘nobody’ in the car… so far so good!

Cllr Norman Webster, aka the Political Tsar of Social Prescribing, hosted the ‘Welcome and Introduction’, with Dr Laura Hill.  It was clear from his address, that Norman is passionate about his community and helping people to make the very best of the hand they have been dealt in life. Dr Laura Hill spoke about the national award-winning Crawley Dementia Alliance which she co-leads and aims to make Crawley a Dementia Friendly Community.

Hearing that Crawley has pioneering Social Prescribing schemes, made me question if there might be a piece of the puzzle missing. I have worked, albeit not in dementia, in Crawley for a number of years within Sussex Community Foundation NHS Trust, yet I haven’t heard of the pioneering social prescribing initiatives there. Whilst community assets are at the centre of Social Prescribing and I can totally understand the focus on GP’s, link workers and the VCS, the benefits of Social Prescribing need to be recognised supported and partnered by the whole system. I found myself looking down the delegates list realising there was no representation from local NHS Trust organisations at this conference which in itself speaks volumes. Getting trusts aligned and plugged in to both social prescribing, personalisation and local initiatives, could be really exciting. I made a note to myself to pursue this further.

As if by cue, the perfect line up of keynote speakers helped me to consider the behaviour change and cultural shift needed to ensure these local NHS trusts are on board and represent Social Prescribing in the future…

Dr. David Paynton used a case study to portray the GP’s perspective of Social Prescribing and Personalised care. He eloquently highlighted how the current system is not meeting ‘Gladys’ ‘ needs with its ‘pass the parcel’ culture.

“We need to work with people, support them to take greater ownership for their health and wellbeing and what’s important to them, and then meet NHS outcomes”.

Nicola Gitsham, Head of Personalised Care, NHSE, talked through how Personalised Care sits within Social Prescribing. Set out in NHSE’s Comprehensive Model of Personalised Care , which links to their Personalised Care Operating Model she described how people want a life not a service. To achieve this we need all sorts of parts of system to come together to enable people to live their lives, their way.

I have had the pleasure of hearing Nicola speak previously. She is really passionate about inclusion and people having person centred support, joined up at the point of the individual so they can live their lives their way. It is inspiring to hear her words. She highlighted that redesigning the work force and changing commissioning and finance should be the heart of the transformation, but reassured us that whilst difficult, it is possible to do at scale. Her main message was that personalised care has a big impact for people, but also the workforce and the system, It is not about saving money but if done well can use resources more wisely.

The result will be:

“Better health and wellbeing for individuals, better quality and experience of care that is integrated and tailored around what really matters to individuals, and more sustainable NHS services”

Bev Taylor, Senior Manager for Personalised Care for NHS England, and Craig Lister were responsible for setting the national and regional scene of Social Prescribing. They introduced both NHSE’s objectives in Social Prescribing and presented a model of Social Prescribing. Bev described social prescribing as a bottom up social movement and reminded us of the social model of health… as little as 10% of a population’s health and wellbeing is linked to access to healthcare. Whilst the vision is to have social prescribing mainstream funded and by 2023 the government has committed to

“Support all local health and care systems to implement social prescribing connector schemes across the whole country, supporting government’s aim to have a universal social prescribing national offer available in GP practices,

A connected society: a strategy for tackling loneliness

I appreciated Craig’s exploration of the ‘trailing edge’. A lot of discussion is on the ‘cutting edge’, but Craig highlighted the merit in looking at the good stuff already there; if we can improve your optimism and make you happier you will receive the health message better and be more likely to engage to improve your health. I also enjoyed the pragmatism, acknowledging that from a risk perspective the worst thing we can do is nothing and anything above that is better. Craig spoke about his passion for evolutionary physiology and supporting health and wellbeing outside the standard medical model. He is currently supporting the development of a triple lock quality assurance process that would enable the scaling of social prescribing across the UK, in line with the publishing of NHSE’s Common Outcomes Framework to ensure social prescribing initiatives can be delivered consistently and measured comparably.

There were two breakaway workshop sessions to attend. I chose to look at how we engage the social prescribing system with wider community assets which certainly did not disappoint. The workshop included a great session on social movement theory and sparked discussion on how we might develop a unified, consistent approach. The potential for ring fenced, shared investment funding for community volunteering was suggested.

After lunch and networking, we were given a minute’s silence to reflect upon the morning and everything we had taken away from it. It was at this moment that I reflected that I was inspired and almost giddy with excitement at the Kings Fund conference which encouraged me to champion my #socialprescribingschemedream, but I found myself struggling at times and would have quite liked the floor to open and swallow me up at this conference. I reflected on why this was? Everyone had been so friendly, I don’t think I had made too many faux pas and I hadn’t spilt lunch down myself despite the precarious nature of attempting to eat at networking events!

I realised this conference was regional and explored social prescribing from a different perspective; the theories, practicalities and realities for those actually setting up, partnering, delivering and evaluating initiatives, on the ground. Quite rightly there was a lot more participation and engagement at this conference from people involved in ‘doing’ social prescribing. I am finding the more I delve into social prescribing and immerse myself in it, the more challenging this initially quite simple concept becomes, certainly to embed. Given that I am still developing my #socialprescribingschemedream surrounded by those who are both practicing and preaching social prescribing, it is understandable that I might feel alone and quite out of my depth.

The second workshop I attended was about developing the South East Social Prescribing network, and it could not have come at a better time for me! Just when I was feeling alone in setting out on my social prescribing journey, Malcolm Bray, South East Social Prescribing Regional Facilitator, highlighted the networks intent to create a space to have a proper conversation, reduce professional isolation, work together and share experiences and challenges. Setting up a platform for individuals to feel part of a community of practise with other like-minded individuals is a fantastic resource not just for me but everyone who has an interest in Social Prescribing throughout the South East Region. Whilst at the Kings Fund Social Prescribing: Coming of Age conference I felt like I was part of a movement, following this conference I know that I am part of a social prescribing community locally which for an individual setting out in Social Prescribing, is a fantastic feeling.

Whilst at the moment I am definitely still at the ideas stage, ‘Collaborating for Growth’ and the networking opportunities this provided, has focused me now on how I am going to shape my #socialprescribingschemedream. I want to look at strategically, how people like me, a health professional, can best engage in this fantastic bottom up social movement, because I believe this is where there might be an opportunity to enhance all the great work that’s started.  My interests particularly lie in nursing, children and young people, health visiting and engaging behaviour change within the NHS towards Social Prescribing. I am going to use both the South East Social Prescribing network, and the Future NHS collaboration Online Platform to immerse myself in the social prescribing community and evaluate how #mysocialprescribingschemedream can be as transformative as I would currently want.

So to conclude, I started the day in the car park nervous about how I was going to fit in at a conference of people delivering social prescribing. At times I was both inspired and disconcerted. But, the main thing is, I finished the day inspired and more determined, with a clear focus and a platform! Being part of the South East Social Prescribing community is an honour. Thank you to all those who collaborate on these sites and make them what they are. Onwards and upwards!

e: socialprescribingschemedream@outlook.com
w: https://socialprescribingschemedreamwithamyfieldhouse.blog
twitter: @FieldhouseA2014

 

 

My take on the Kind’s Fund 2018 Social Prescribing: Coming of Age conference

I AM ABSOLUTELY DELIGHTED TO BE WRITING THIS BLOG! I SET MYSELF A TARGET THREE MONTHS AGO TO BE AT THE KING’S FUND SOCIAL PRESCRIBING: COMING OF AGE CONFERENCE ON THE 6TH NOVEMBER 2018, AND I GOT THERE!

BOY DID IT DELIVER! THE ENERGY AND ENTHUSIASM IN THE ROOM WAS CAPTIVATING.

Please read my guest blog entry about the day here on Elemental Software’s webpage.

Not only did I get to the conference… I got sponsored by Elemental and have a guest blog entry on their website

#success

 

Elemental-Software-logo2-smaller-1

Getting myself out there!

Theres nothing like creating a tall order for myself! If I wanted to pave a way in social prescribing as little old me, without a professional body (see previous blog, whilst I am a health professional, I am not currently using my day job to progress in social prescribing), then I needed to connect myself somehow! I decided to set myself some goals!

I promised myself I would get on Twitter.  I would get actively involved in the @SocialPresHour. I decided I would write a blog about my progression (Hey Presto!). I would start networking locally and nationally by going to forums such as the Personalised and Proactive Care Forum by the Healthy London Partnership and engagement events such as the Big Health and Care Conversation locally known as High Weald Lewes Havens. I would meet with providers and professionals of the social prescription pathway locally e.g Age UK, Care for Carers, the link workers and community navigators currently in post. I would keep making contact with local GPs (at time of writing still no replies) and I would be bold and ask Community Practitioner (the journal I subscribe to as a Health Visitor) whether I could write a journal article about what social prescribing means to me.

I tried not to think to hard about what I was doing because I think if you think to much about anything, you can talk yourself out of it! Some days I ask myself why am I doing this, I am not being paid, I am not part of any organisation or body that is supporting me which in itself means I hit brick wall after brick wall, but then I remind myself… I am a good, honest person. I am not bound by silos and organisational constraints and that is quite refreshing and exciting! And what am I doing it for? My end goal is to try to improve health and wellbeing and install some confidence and resilience in humanity, when lets face it, times are tough!

I set myself the target of getting sponsorship to go to the Social Prescribing: coming of age conference on the 6th November 2018, hosted by the Kingsfund. This was absolutely key to me, because I felt if I could just get someone to believe in me, and enable me to get to that conference, then, it was hope.. it was proof.. I can do this… I have a worthy #socialprescribingschemedream.

beach ocean sand sea
Photo by Pixabay on Pexels.com

When did this all become social prescribing?

To answer the questions I asked myself in my previous blog ‘First Steps‘,  I started by reading… particularly the work by Jo Cox on combating loneliness. I found growing momentum behind the consideration that loneliness is a growing health epidemic and I was shocked and determined to do something when I learnt social isolation could be associated with a reduction in lifespan similar to smoking 15 cigarettes a day.

I met with some charitable organisations and social enterprises locally. I am very grateful for the time and contacts they gave me. Artytime in particular was useful because the differences between a social enterprise, charitable organisation and community interest company was explained. I was also given a taster of the world of pitching concepts, funding, starting and evolving community projects and remaining relevant.

I wanted to know more about services for the elderly so I went to meet the Croydon Health Visitor For Older People service. Being a Health Visitor for children 0-5, I was interested in what Health Visiting at the other end of the spectrum looked like. I could not be more thankful for the time I spent here. It was pivotal because above all this taught me just how important I find holistic care. So many services target a part of a person, but the HVOP aim to bridge the gap between health and social care by considering the individual as a whole, not one condition, diagnosis or limb. They also work tirelessly to keep a simple referral criteria so that an elderly person who isn’t coping but does not fit the criteria for other services, is seen rather than left to decline until they trigger need for acute services. We had a lot of discussion about the battle to keep referral criteria simple and open, in an age of increasing targets, and we discussed at length how to measure a preventative service which runs the risk of being considered a luxury in austerity.

It was at this point that I read the 84 page document Making sense of Social Prescribing by University of Westminster from cover to cover, with ease, and realised I was on to something I was really passionate about. I am most excited because I can see sustainability. For me; (social prescribing is an area I would love to specialise within and become an expert in), for patients; (what could be better than enabling people to engage with what matters to them, and better their own health in the process?) and for the future of the NHS (by building community capacity and resilience we enable people to take control of their own health and free up NHS services for those that need it).

Social prescribing incorporates a lot of my skills, experience and interests. Where else can you combine experience from A and E and triage, interpersonal care and communication from working with children with complex needs, public health education from a degree in public health, paediatrics, Looked After Children , voluntary work with Crisis at Christmas, knowledge and interests in Community Fridge (Frome), the Foodbank and Parkrun, and there be a chance I can draw upon my diploma in Tropical Nursing when considering community engagement?

I realised that I want to keep within my background as a health professional rather than set up a community enterprise/charity/start up which is something I have no clue about. There are plenty of wonderful charities locally. I want to use my experience knowledge and interests to get social prescribing embedded within services locally and get people accessing the voluntary sector.

Probably in the wrong order, I contacted local GPs and asked if they knew about social prescribing and if I could be involved with social prescribing in their surgeries. I liaised with my local CCG and found out social prescribing already exists in the area. At this point I could have called it quits and aspired to be a lady that lunches (see previous blog)

However, No, thats not me. Social prescribing is complex because health is complex and constantly evolving. Whilst some steps have been taken locally there is so much more work to be done and so the #socialprescribingschemedream started.

First steps…

My #socialprescribingschemedream is rapidly evolving all the time and I am happy with this. I am choosing to roll with it and ‘enjoy the journey’ if you forgive the cliché. I find I’m having lots of ideas and just want to clarify that by writing in the past tense in the following posts, does not mean I have discredited any of them or they are not current. Naturally some ideas get more airtime and develop further than others, but to keep you up to date and the blog accurate, I am backdating my first concept, which was prior to the idea to blog, and involved a cup of tea! Anyone who knows me knows I love a cup of tea.

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My idea was to tackle loneliness by encouraging the elderly and primary care givers of children under 5, to befriend one another over a hot drink. I considered it my ‘oldies and tots proposal’. Initially I wasn’t exactly sure where the meet up would be, but given I was keen to tackle loneliness and isolation I did not want to make this a group.  If people are well enough/confident enough/capable to get to a group you could access the many other wonderful groups set up in the community. My experience of preschool groups, albeit very positive, is one of noise, chaos and distraction and I wasn’t sure I wanted to be responsible for either putting elder generations through this or trying to manage it! But, more importantly, people often put on a front when they enter a group setting. I wanted to facilitate a real 1:1 companionship for the isolated or lonely. Where its ok to confide, and its ok to not be ok in front of each other. I considered this contact being in people’s homes.

Why do I want to bridge the gap between generations? Families are becoming more spread out geographically. There are many reasons for this, but in a very interesting TedTalks, by Courtney Martin highlighted that our strive for autonomy, independence and the ‘white picket fence’ of the ‘American dream’ come at the cost of our support networks. It is mutually beneficial for young people to spend more time with old people.

  • For the elderly person they become more active being around babies and toddlers, they receive love, warmth and touch which they may not have experienced for a period of time, and they are distracted and engrossed by the child, perhaps forgetting their situation and circumstance during the contact.
  • For the parent/guardian of the child, the older person provides someone who will listen, who is wise and has the benefit of life experience. They also provide the parent/guardian the opportunity to observe their child play. When I get the opportunity, I love to watch my children and their interaction as this is a novelty from being involved in the engagement. Having an elderly person around for tea could also provide a parent/guardian with a brief opportunity to complete a household task that might well be mounting up causing stress and anxiety, whilst the elderly person and child entertain one another.
  • For the child the interaction teaches them life skills; how to behave around different generations, how to respect their elders and to adapt their play and behaviour accordingly and also they benefit from wonderful stories being passed from generation to generation, which would otherwise be lost.

In a society of social media, increased loneliness and isolation, I wanted to make time to enable conversation and support between strangers.  The USP to this concept is enabling individuals to help themselves. A buddy system not reliant on a setting or a provider to facilitate, but reliant on individuals #salutogenesis. At this stage in my #socialprescribingschemedream I was considering carrying out a home assessment, linking people, (matchmaking if you will!) DBS’ing them and then offering support if and when required, but allowing Twinnings to do the rest! (other brands are available!)

3 main questions I asked myself:

  • How am I going to find these lonely and isolated, vulnerable people? Could I be referred them via GP’s, health visitors and district nurses?
  • How would I keep both parties safe? Risk of abuse, risk assessments, vetting and the general huge vulnerability of all parties would all need to be addressed. Whilst I did not have the answers to this, and I knew it was a huge area, it seems mad to me to put a close to a great idea that could help the majority, for the minority that potentially ruin it. There must be a solution.
  • What is this? Is it a charity? A social enterprise? A health service I want to have commissioned?

I spent the next few months of maternity leave reading, asking even more questions and not necessarily answering any, but enjoying the process, and meeting as many people as I could who may be able to shape my idea.

Whilst I have lots more to write about how this concept evolved and who I have met along the way, if I jump to the present for a moment, I am very excited to see in the media over the last few days the Prime Minister’s commitment to tackle loneliness and the launching of the loneliness strategy. Wow! This is brilliant. Naturally the media have got really involved in loneliness as a result and I am really enjoying reading and tweeting about various local and national projects looking to tackle loneliness. Two projects I thought I’d mention include the Sainsburies ‘talking tables‘ initiative and local to home ENGage ‘traveling tea trays‘. Both these projects give me confidence and encouragement that my ideas are on the money, and social prescribing is definitely in vogue!