Looking beyond clinicians for health and care

Stefano Gortana

3 October 2017

Some interesting themes and trends have emerged from sessions at the Conservative Party Conference related to healthcare, digitisation and innovation. Underpinning multiple discussions has been the dire need to accelerate the integration of health and social care services; the need to rely more heavily on local services, within and beyond the clinical setting, to provide a more holistic health service.

While certainly not a revolutionary idea, debate around integration of services and the inclusion of additional actors in the provision of health and care had highly noticeable urgency, and even desperation - why aren’t we doing this already? There was a clear consensus that it needs to happen and a general frustration, often boiling over into anger, that it hasn’t already - why aren’t we replicating successes and learning from our failures?        

The need for integration is uncontroversial

Almost every session has acknowledged the ‘pressures on the health service’ or the ‘exceptional rising demand’ for health services. What can easily be disregarded as a throwaway line does have very serious implications for the provision of healthcare in the UK, including the need to get the most out of every pound being spent as well as every clinical and non-clinical service available.

Faced with limited resources, workforce pressures (exacerbated by Brexit) and inexorably rising demand, the NHS desperately needs additional support; some also say better productivity. However, whilst hospitals are overbooked and patients with long-term conditions still rely overwhelmingly on their GP as their point-of-contact with the NHS, other services such as pharmacies remain under-utilised. In the absence of substantive additional funding (and probably even if it were forthcoming), the UK clearly needs to accelerate the incorporation of supportive non-clinical services alongside the NHS, if health services are going to improve.

Social prescribing works

Social prescribing can be understood as ’an activity and a process which may be experienced in a range of settings or contexts. Ultimately it involves access to a range of non-clinical interventions and activities which can impact positively on individual wellbeing and resilience‘.  As ’people’s health is determined primarily by a range of social, economic and environmental factors‘, it should be no surprise that research shows that social prescribing leads to improvements in areas such as quality of life and emotional mental and general wellbeing, and reduced levels of depression and anxiety. Studies have even shown that social prescribing schemes may lead to a reduction in the use of NHS services.

In fact, rather than a mere reduction in use of services, a major evaluation of the effects of social prescribing showed that for each £1 invested into the scheme, there was a £1.69 saving. Partly for these reasons, a survey of 1000 doctors found four out of five thought social prescriptions should be available from their surgeries. Centres such as Bromley-by-Bow Centre in Tower Hamlets have done pioneering work in improving the health of patients and communities via the use of supportive services from allied and non-health professionals.

Not without challenges

The prospect of providing a more holistic health service does, however, come with challenges, which may in part account for the delay in widespread adoption. Health Education England notes: ‘information management and infrastructure development isn’t currently happening in any systematic way nor are developments being shared’. Furthermore, there is a danger that evaluation efforts may be politicized, while uncertainty of funding undermines the sustainability of progress.

It is important to remember what patients want - it is not a massive team of clinicians involved in their care, but a preference for continuity and coordination across the various services they are being offered. Thus integration and social prescribing comes with additional responsibilities for the health service to improve sign-posting and provide clarity regarding the NHS system, its infrastructure and the roles of diverse clinical and non-clinical professionals in the provision of health services.

Patients need clarity in order to have suitable trust in the health service. The integration of health and care, including the evolution of social prescribing, carries the potential for vast improvements in quality of care, but also increased confusion and uncertainty. Efforts to eliminate such confusion will be crucial to the success of greater integration of social and allied health care. But the question remains, will the energy and frustration expressed by so many at the Conservative Party Conference and fringe events result in any tangible action to accelerate implementation?

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