Never waste a crisis: reflections on social prescribing and COVID-19 in West Hertfordshire
In 2014, Herts Valleys clinical commissioning group (CCG), in partnership with Hertfordshire County Council, commissioned four voluntary organisations to provide six community navigators. This service was built on HertsHelp – a county-wide single point of access for expert telephone triage to 12,000 entries on a local community database.
The navigators soon showed the difference they could make by ‘getting alongside’ people who needed – but would never ring – HertsHelp. The service was expanded into the countywide Hospital and Community Navigator Service (HCNS) during 2018.
In 2018-19, the navigators had supported 10,000 clients, with high client and referrer satisfaction matched by powerful case-studies. Using a well-established tool for measuring mental health, the Warwick-Edinburgh Wellbeing scale, we saw an 11% improvement in mental wellbeing. We also used the Campaign To End Loneliness Measurement Tool, which showed an 18% reduction in loneliness.
A pilot used an algorithm to identify people using A&E ten or more times a year for non-clinical reasons (as confirmed by their GPs). Reaching out with social prescribing support, three High Intensity User (HIU) workers helped people reduce A&E use by at least 40%. This was our first ‘outreach’ service.
By 2019 the initial four voluntary and community sector (VCSE) partners had grown to nine. At this point, the NHS Long Term Plan mandated the provision of social prescribing services as part of its commitment to a new model of personalised care for the NHS. Building on this, the GP network contract for 2019-20 introduced social prescribing link workers as part of the additional roles to be introduced into primary care networks (PCNs). This gave HCNS the chance to work with the newly formed PCNs, by employing most of the new link workers on their behalf. Business continuity was guaranteed by integrating the new link workers with the 20 strong navigator service, and it meant that the link workers were supported as part of a local team. This integrated approach has since proved invaluable.
The new PCN social prescribing link workers were inducted in December 2019. Initial feedback from the VCSE raised concerns that we needed to look at the balance between ‘travel agents’ and ‘holidays’. In other words, more link workers introducing people to community activities and support would only work if there were sufficient, robust community resources to refer into. And so the CCG was about to invest £400k in local grants so that the link workers could help community assets to develop.
And then COVID-19 hit.
The link workers, like the VCSE sector in general, swiftly turned into remote outreach workers, calling shielded and vulnerable people, offering practical and emotional support (occasionally in the early chaos delivering food parcels to desperate people themselves). The PCN link worker team was expanded to include the HIU navigators and six mental health link workers (being piloted with Mind) broadening capacity and skills-base and building resilience against sickness and self-isolation. Senior navigators, district councils and Adult Care Services shared lists to minimise people missing out or wasting resources on people already supported. A link worker follow-up call for patients with suspected COVID-19, at day seven and 10, took pressure off practice staff.
Having expanded HertsHelp’s capacity by 400%, including emergency funding and seconding in of Carers in Herts and Mind workers, Herts County Council leafleted every household. On one day in April, 650 people who had previously not known what to do, called HertsHelp for support.
We won’t waste this crisis. Old barriers are down. Despite huge challenges, the VCSE sector has shown amazing flexibility and responsiveness. Doctors are speaking directly to them to find local solutions. Volunteers have poured into the system (10,000+ in Herts, not including 15,000 NHS Responders). We’re analysing challenges to the sector and will spend the £400k (suspended along with business as usual) as part of recovery, using the statutory sector’s awareness of its reliance on the VCSE sector to argue for more. Seconding furloughed VCSE workers temporarily into additional link worker roles is being considered.
The future of social prescribing
We knew social prescribing was a key tool for integration. The crisis framework of outreach and wellbeing-calls by PCN link workers can now morph into strategic use of the power of the community to attack the health inequalities highlighted and exacerbated by COVID-19. In the words of NHS England and Improvement Chief Executive, Sir Simon Stevens, we must take ‘this opportunity to lock in beneficial changes that we’ve collectively brought about in recent weeks…’ We mustn’t forget the crucial role the VCSE sector – and social prescribing – has played in getting us through the crisis.