Social prescribing is sometimes seen, wrongly, as an approach that mostly benefits middle-class people. NASP's Joelle Bradly explains how the data suggests that this simply isn’t the case.
A recent study from University College London shows that social prescribing is supporting people living in deprived areas far more than people in less-deprived neighbourhoods.
The research focused on data records of more than 160,000 patients, provided by Access Elemental, and showed that 45.9% of the patients referred to social prescribing in England live in the three most economically deprived deciles. If referrals were balanced evenly across categories of deprivation, the figure would be around 30%. The highest proportion of referrals into social prescribing came from the most deprived areas.
The research echoes the findings from the cross-Government Green Social Prescribing programme, in which 57% of participants lived in the three most economically deprived categories of neighbourhood. Data from the Oxford Social Prescribing Observatory from 2021-23 also suggested higher rates of referrals from more deprived areas, and this is backed up by other data from NHS records and the English Longitudinal Study of Ageing.
However, separate research from NIHR suggests that there is more to do to ensure that Social Prescribing Link Workers are recruited in the geographic areas with the highest needs. In other words, while social prescribing is far more likely to reach people who live in deprived neighbourhoods, it is important to look at barriers to recruitment in some parts of the country.
There is also a need for better data overall, with more consistent reporting on who is being reached, what support is offered and on outcomes.
Targeted approaches
It is not surprising that social prescribing is particularly reaching people in more deprived areas. In England, there is a 19-year gap in healthy life expectancy between the most and least affluent areas of the country. People in less well-off areas are more likely to live with poor health – and in many cases, this is related to their social circumstances.
Social Prescribing Link Workers have more time than medical professionals to get to know patients, understand their circumstances and help them access appropriate support, based on what matters to them. In many cases, this includes helping people get advice on debt, benefits or housing.
Increasingly, through proactive social prescribing, services are specifically targeted at people experiencing deprivation. In some cases, social prescribing is offered to people in more deprived areas living with long-term conditions, including lung conditions or survivors of heart attacks.
Another example is the approach taken by Bromley-by-Bow Health. The service has modified its Long Term Condition Care Plan and included several questions that ask patients with long term conditions about key wider determinants of health (money, debt, housing, loneliness, skills and employment etc). The responses to the questions are entered into the patients' medical records and updated periodically.
Bromley by Bow Health’s four GP practices have 50,000 registered patients, of whom around 9,000 have a long term health condition. In 12 months, they have asked the wider determinants screening questions of 6,500 of them. This has led to a 15% take up of the offer of proactive, data-informed, preventative social prescribing. This approach has now also been adopted across Tower Hamlets and some other North-East London Boroughs.
What is the impact?
There is a wide range of evidence showing the positive impact of social prescribing in general. One recent example is the independent evaluation of the Green Social Prescribing Programme, which particularly worked with people living in deprived areas and led to statistically significant improvements in mental health for participants.
We also recently published a report on the relationship between social prescribing and health service use: many of the studies we cited also looked at patient outcomes and showed improvements across a wide range of measures.
Overall, there is strong evidence to show that social prescribing can reduce loneliness, benefit wellbeing and mental health and make a difference to people living with a range of physical health conditions.
There are huge, long-term and systemic challenges in tackling health inequalities, and social prescribing is clearly not a means to address all of these. However, at an individual level, it can make a significant difference.
Link workers give countless examples of how they have supported people, directly or through referrals. Whether that’s helping someone with asthma to get damp and mould removed, enabling a carer to join a group that boosts their wellbeing, or supporting someone living with depression to find work that they enjoy, they can focus on what matters to each person in a way that benefits their health.
