08/03/2024 Creating the culture for social prescribing to thrive in Walsall

Helen Billing, Head of Partnerships and Development at Walsall Together, tells us how they have brought together a partnership committed to high-quality social prescribing that responds to the needs of communities.

• Trust your people. Social prescribing link workers will always find a way! Use relational approaches rather than forms and surveys.
• Be very clear and purposeful in raising the profile of social prescribing with senior decision makers.
• Social prescribing link workers are invaluable as “eyes and ears on the ground”, offering insights and intelligence about health inequalities, experience of and access to healthcare, and the wider support offered in an area.
• Respond to these insights on health inequalities with focussed support.

The 2019 Index of Multiple Deprivation ranks Walsall as the 25th most deprived English local authority and almost 1 in 4 residents are from a minority ethnic group. The difference in life expectancy between the most affluent and most deprived is eight years.

It was recognised that social prescribing could address the wider determinants of health for these deprived communities, but only if it was a responsive, community-centred service.

There were three main approaches to social prescribing link work in Walsall: within primary care, within whg Housing Association, and within Making Connections, a third sector offer based in community associations. There were also a number of similar and associated roles elsewhere.

Many partners valued the input of social prescribing link workers and wider support from the Voluntary, Community and Social Enterprise (VCSE) sector to help people live well. However, the different offers were not always understood and coordination between them was sometimes lacking.

We therefore decided to consolidate our approach to social prescribing across the borough, with the aim of promoting wellbeing, addressing health inequalities, and enhancing the position of the VCSE sector.

We set out to change the culture around social prescribing, considering both practical and strategic aspects.

One of the main strengths was the quality and wisdom of the lead practitioners. We set up a network for those social prescribing leads which was purposely relational, inclusive, and informal. Quite quickly trust and cohesion was established, with natural sharing of ‘high spot’ successes and new resources, as well as ‘hot spot’ gaps and issues for citizens/patients.

The themes around health inequalities emerged naturally from conversations:

• People unable to take up support due to costs of transport
• Care leavers struggling to manage their lives
• Terminally ill people struggling to maintain tenancies.

Once we had the trust and shared purpose, we developed a simple summary of the offers across the different models and agreed quality statements. Throughout we ensured that the important differences between models was celebrated. It was a ‘federation’ of equals rather than a ‘takeover’.

In parallel, there were discussions with key strategic leads in the areas of social prescribing and more broadly. There were some quite polarised views about quality and standardisation. We produced high-profile papers to senior board and committees outlining the value and practices of social prescribing. We facilitated social prescribing leads’ contribution to the documents as well as the meetings, underpinning their values, experience and profile.

One of the main challenges for social prescribing link workers was, and still is, capacity. They are all very busy and colleagues may ask them to undertake activities which are outside their role. It requires constant vigilance and support to enable them to work at their best. Sometimes going the extra mile, for those furthest from services, can be difficult.

Many people misunderstand the role of link work in social prescribing and it is hard to put across on paper. We have found that having link workers in the room with partners, telling real and recent stories, has been invaluable in demonstrating their benefit, as well as influencing action to be taken as a result of that ‘soft intelligence’. For example, we have been able to influence housing issues for people at the end of their lives and facilitate free public transport to enable access to both hospital appointments and wider activities.

Sustainable funding for the social prescribing link workers and the wider VCSE sector was and is a huge issue: many of the link workers are on fixed-term contracts and many of the activities they refer into have short-term funding. While this issue is not yet resolved, there is a wider understanding and a strategic intent to improve this position in 2024/25, linked to ambitions to improve wellbeing and therefore the prevention of ill health.

We are continuing to develop our cohesive offer, continuously welcoming new approaches to social prescribing into the ‘family’. We will be developing a sustainable approach to funding both link workers and VCSE sector organisations.

We will also be increasing our emphasis on health inequalities. To date, much of our focus has been on cost of living and poverty, but the people we help experience a range of disadvantages.

Read more about Walsall Together’s approach to wellbeing.