A social prescribing service for people living with long-term conditions in Newcastle has led to a 27% reduction in hospital costs for those patients.
Context
The Ways to Wellness long-term conditions service launched in April 2015 in the west of Newcastle upon Tyne. It is an area where deprivation is higher than the average in England, life expectancy is lower and where people with long term health conditions experience high rates of unplanned admissions to hospital.
The social prescribing service supports people aged 18-74 years old with specific long-term conditions, many of whom have multiple, complex medical, practical and social needs. The eligible long-term health conditions include diabetes, heart disease, chronic breathing difficulties and epilepsy.
The service was set up with two overarching aims: (a) to improve the health and wellbeing for people living with long-term conditions in the west of Newcastle; and consequently (b) to reduce NHS costs related to their care.
Approach
GPs, nurses and hospital and community healthcare professionals can refer people living with long-term conditions into the service.
The service then provides patients with a link worker to help them identify and work to overcome their current barriers to managing their long-term conditions. The link workers will work with patients to produce an agreed action plan, which may include a range of activities, such as:
• Getting involved in local groups and activities
• Developing positive relationships
• Accessing specialist services and support
• Healthy eating and cooking
• Getting more active
• Getting support around benefits and welfare rights
The service aims to improve patients’ quality of life and reduce their use of mainstream health services by enabling them to lead healthier lives and better manage their conditions.
Clients remain with the service for an average of 18 months, which allows time for them to achieve multiple (and often progressive) goals across a wide range of areas that link to wellbeing. The longer-term service helps to ensure that changes they make are sustained.
Results
The programme has achieved both improved wellbeing for participants and a significant reduction in secondary care costs.
Analysis of 2,888 clients who engaged with the service and were subsequently discharged in the first five years of the service showed that 86% improved their wellbeing in at least one domain of wellbeing.
Secondary care costs were measured by comparing the average hospital cost per person in the Ways to Wellness cohort with a matched group of patients that do not have access to the Ways to Wellness service. In 2019/20, the secondary care cost per patient for the Ways to Wellness cohort was estimated to be 27% lower than the comparison cohort.
The cumulative costs avoided in secondary care have been £4.6 million over 5 years.
In total, from 2015 to 2021, more than 7,700 referrals were received, of which over 5,800 people engaged with the service. The most common support clients were signposted for were: 27% healthier behaviours (e.g. exercise, healthy eating, weight loss); 18% financial or benefits advice; and 11% support for long-term condition management.
Since 2022, the success of the service has meant that it has expanded into other parts of Newcastle as well.
What went well?
This programme had a pioneering funding model.
The Ways to Wellness long term conditions service was established as a partnership across public sector commissioners, private sector investors, and voluntary sector service providers. Ways to Wellness was a non-profit ‘special purpose vehicle’ with a small team managing the contracts, providing a platform upon which to build processes to support partnership working, and capturing and sharing learning.
It was the first health service in the world to use Social Impact Bond (SIB) investment, paired with a fully outcomes-based, seven-year NHS contract. The contract payments were 100% on achieving two outcomes: a) improvements in patient-reported wellbeing, and b) reductions in secondary care costs.
This meant limited risk for the NHS commissioner, although the success of the programme meant that Ways to Wellness have been able to fully repay the social impact bond.
What were the challenges?
The national roll-out of social prescribing from 2019 had implications for Ways to Wellness, with more social prescribing happening through Primary Care Networks across the city – leading to changes in recruitment and impact measurement. The COVID-19 pandemic also created challenges, although the service was adapted to operate remotely.
Next steps
As a result of the learning from the Long Term Conditions model, Ways to Wellness has successfully developed and tested similar social prescribing models of support in other clinical areas.
Their prototypes include Maternal Mental Health support in the perinatal period, supporting families who have a child with a chronic condition, waiting list support for orthopaedic patients with higher levels of chronic pain medication and for support for people experiencing persistent physical symptoms.
Resources
Further resources and case studies on social prescribing and long-term conditions
