Put the 'social' into social care

What this means 

The word social implies community and relationships. Social care should embrace this aspect of its work, prioritising and celebrating work that fosters connection. 

This doesn’t have to be expensive or difficult. It could be as simple as going on a walk with someone who doesn’t have the confidence to do this on their own.

Innovative approaches - adding social to social care

Here Bob talks about innovative approaches which can add the 'social' to social care:

The research 

Making use of community resources, and connecting people with resources in their local area, is included in the Care Act 2014. In addition to the legal context, people generally wish to be part of their chosen communities, whether geographical or a community of interest, and be sociable with those they enjoy spending time with. It can also be a big part of someone’s health and recovery – for example, Wang et al. (2018), looking at mental health difficulties, found that if someone had higher perceived social support in their community they were less likely to experience more severe symptoms, and to experience better recovery, from a wide range of mental health issues. 

‘Social prescribing’ is a term generally used to describe non-medical options that could be available to health and social care professionals, and usually coordinated by a link worker or community connector (Polley et. al, 2017). However, social prescribing is more than simply pointing to activities – it is a holistic approach that connects health and wellbeing with social, economic and environmental factors, and aims to support people to take greater control of their own health and wellbeing (Buck & Ewbank, 2020). 

Many, if not most, of the ‘socially prescribed’ activities are community-based activities - such as arts and creative activity groups, gardening, volunteering, or team-based sports. Although much of the evidence relates to its use in healthcare – for instance, in terms of how it could potentially reduce GP appointments and pressure on primary care – the broader findings on wellbeing and accessibility are of direct relevance to social care professionals. 

While there remain weaknesses in the evidence base – many studies are small-scale, do not have a control group, focus on progress rather than outcomes, or relate to individual interventions (Buck & Ewbank, 2020; Elliott et al., 2022) – some key themes have emerged: 

• The person needs to believe that social prescribing will address a particular and personalised area of their life that they want support with (rather than something more generalised). This then allows them to decide whether the activity is working for them. 
• The person needs to believe those running activities are sufficiently reliable and skilled to address their needs – this is a big factor in whether people will continue to go after an initial session. 
• People may need extra support, including printed information or someone to accompany them, the first time they go to an activity. People found a printed referral form, that they could give to activity organisers as an introduction, particularly helpful. 
• The way the ‘referral’ is presented has an impact on how it is acted on. There is no one rule to this; some people appreciate social prescribing being presented as a suggestion, whereby they feel an equal stakeholder and able to make a positive choice; others respond better to a more directive approach. 
• Proximity and accessibility are key; even if people have private transport, or public transport links are good, activities that are too far away can feel intimidating (you can also consider the theme of physical access here). 
• Similarly, people will have different preferences and needs as to the time of day an activity takes place. Some people may like evening activities, while others may not wish to be out after dark, and, for some, medication regimes may influence the time of day they feel most able to be part of an activity. 
• Transport is a key issue - how people get to places (and return home). 
• Following up via a phone call, being interested in how the activity went, asking for the person’s experience, can all help people return – or quickly find an alternative that may suit them better. Having someone to encourage and support is considered key to success. 

(Husk et al., 2020) 

Men’s sheds may be a particularly interesting example of the potential of social prescribing. Kelly et al. (2021) found them a way to address potential gendered issues in relation to health, such as men being less inclined to seek help for mental health issues. The informal and flexible nature of men’s sheds means that activities can easily be tailored to the specific needs of individual men. 

Finally, these issues may be particularly important if someone has recently moved house, particularly as an older person. While moving in later life is often linked to improving physical living environments, being away from a known community can be especially unsettling (Wu et al., 2015) and support to engage in a new community can be invaluable. 

What you can do 

If you are in direct practice: Social prescribing isn’t only for GPs, or those with a ‘community connector’ job title. Its principles can be used in all kinds of direct work. Think about the following: 

• How do assessments and care plans currently address people’s needs for connection and community? 
• When discussing community activities, how can you explore with the person about the potential effect this may have on their specific mental and physical health needs, rather than focusing on generalised impacts on wellbeing? 
• Do you ascertain whether people need extra support, including transport, to access community activities? Are there creative, low-cost solutions to this? 
• How do you follow-up with people’s community activities – can you phone them to see how they found it, particularly after their first session? How can you measure its success?

In some areas, social care practitioners can refer directly to social prescribing teams; if you are unsure, a clear action to take is to clarify this, so you can refer directly in the future if this is possible. Even if a social prescribing team doesn’t take your direct referrals, you can still explore the possibility of closer working relationships with them.

Further information 

Read

NHS England has a guide to social prescribing and community-based support. 

New Frontier Economics has a guide (aimed at policy and strategic staff) on the effective use of data in social prescribing.

Listen

The National Academy for Social Prescribing has a podcast series on social prescribing. Highlights include the healing power of heritage, interacting with nature and the mental health benefits of fishing.