“It isn't conventional” to have social prescribing in a hospital setting, Dr Andrew Wragg, Medical Director at St Bartholomew's Hospital in London explains, but a new social prescribing programme within their cardiology department is certainly showing encouraging outcomes so far.
In an innovative and unique approach, heart attack patients are being screened with one social deprivation question by an Advanced Clinical Practitioner (ACP) as part of their recovery. They are asked “Do you have difficulty meeting ends meet?”. So far, one third of patients have answered yes and have subsequently been offered a referral to a community connector embedded within this acute secondary care setting.
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Socioeconomic status as a health risk factor
Dr Tara Mastracci is the Endovascular Lead for Complex Aortic Surgery at St. Bartholomew's Hospital, and the Social Prescribing Lead at East London Cardiovascular Disease Prevention Group. She set up the social prescribing programme within the cardiovascular pathway at the hospital, with funding from Barts Charity and with the support of The Bromley-by-Bow Centre. Â
“The burden of cardiovascular disease has been proven to be higher in patient’s experiencing deprivation in almost any jurisdiction that it’s studied in”, Tara explains. With over twenty years’ experience, she and her colleagues witness first-hand how some patients have factors “stacked against them” making them not only more likely to have a heart attack in the first place, but their recovery process and ability to respond to treatment also becomes more of a challenge. In one recent study, it was shown that heart attack patients from a socially deprived background are at a 53% greater risk of premature death and a 58% greater risk of readmission to hospital.
“There’s been this gap in being able to respond to patient’s needs when they say that they have financial or social issues, and there has been no place to point them in the past”, she continues.
This is where social prescribing in a hospital or other secondary care setting can make a real difference.
The role of social prescribing in a hospital
Moremi Omisore-Adjei is one of two Social Prescribing Link Workers, known as Community Connectors, who now work with heart attack patients who meet the criteria for the programme at St Bartholomew's Hospital.
The Community Connectors are able to provide the time and space for the patient to address their needs and establish a plan to help them. “I typically refer individuals to financial support, helping them to access money they don’t already know about. For example, they might be eligible for personal independence payment” she explains, and this support can help patients who might be unable to work due to their ill health or other difficulties in their life.
Moremi will also refer patients on to physical exercise activities, housing support, or talking therapy to help them process the trauma of a heart attack. She gives the example of a recent follow up phone call with a patient about a missed appointment. In spending time talking to the patient, she discovered an additional social care need that hadn’t previously been picked up in conversations with the medical team. Moremi was able to set things in motion for a package of care for the patient.
Results and findings so far
Economic analysis of the programme is ongoing, but the early anecdotal results show promise. Moremi says “so far we’ve noticed that the majority of patients we see are male, about 60%” which contrasts with patient demographics typically seen in social prescribing, suggesting that social prescribing in secondary care could compliment primary care and reach a wider group of the population. Tara is also optimistic about the impact of the programme on cardiology staff, including the Advanced Clinical Practitioners, working directly with patients, who are now able to direct patients to the help they need. For the hospital, Andrew explains that social prescribing has the potential to make real impact, he says, “social prescribing can have a real impact for individual patients, for populations of patients and real material benefits for the hospital” and as patient outcomes improve the hospital can provide more efficient care.
“I would consider [social prescribing] to be one of the priority innovations that any hospital leader or executive should be considering, especially with the evidence we know about the significance of social deprivation to clinical outcomes and success of treatments” Andrew says.
