Social prescribing in practice

It is easy to assume – especially for nurses in a suburban setting – that life in the country is idyllic, with pretty cottages with roses round the door and neighbours looking out for each other. The reality is very different, with many patients in rural areas experiencing very real social isolation, limited transport links and a paucity of local services

Community nursing services are often overstretched, and providing healthcare to scattered communities can be challenging.

Often patients with no real medical need for inpatient care have to be admitted to hospital because of immobility or a lack of social support. Many are reluctant to seek help because they fear that it will be assumed they cannot cope with independent living, and may be forced to go into a residential care home.

The practice where I work was taking part in the 100-Day Challenge, a pilot scheme in Essex that aims to reduce avoidable admissions for conditions such as minor falls, non-complicated infections and non-acute confusion.¹ As part of this Challenge, I formulated a proposal for a social prescribing initiative to bring together people who needed support and guidance in order to remain in their own homes and agencies that were able to provide assistance.

Social prescribing is an approach that aims to improve people’s health by tackling their social and physical wellbeing, typically by offering exercise groups, help with healthy eating and emotional support groups. It has been promoted as a ‘low cost, high impact’ intervention for problems that may not have an entirely medical solution.

The Help Hub was created to provide a non-clinical setting for these two groups to meet, in an informal, relaxed environment. The aim was to reduce the pressure on primary care by assisting patients to find help with their non-medical needs, improving their quality of life and reducing the chance of unplanned admissions to hospital.

As local transport links are extremely limited, I felt that the Help Hubs needed to be brought to the villages, rather than have a central Hub and expect already isolated people to try to attend.

I chose not to emphasise the ‘health’ aspect of the Hub, focusing more on the word ‘Help’, to avoid putting off those members of the public who are reluctant to ask for social care in case it is felt that they would be better off in a care home – it is surprising how many people are suspicious of the well-meaning healthcare professional trying to help them to maintain their independence.

The response from both the public and agencies was encouragingly positive. Among the support groups who were invited to participate were Age UK, Diabetes UK and Parkinsons UK. We also had support from local service providers including the local community physiotherapy service, the Admissions Avoidance/Home-from-Hospital service and Falls Prevention service as well as local transport and home care providers.

This work also supports my role as Lead Frailty Nurse and Admissions Avoidance Co-Ordinator. I now have an excellent network system involving the voluntary sector, other healthcare professionals, multidisciplinary team members and community support agencies. This resource is invaluable, particularly on a Friday afternoon just before the surgery closes, when we often have a call from a worried friend, neighbour or relative about a patient in crisis. They may not have nursing needs but without swift input from one or other agency may be at risk of admission to hospital. Equally, we often find patients have been discharged from hospital on Friday afternoon without a support network in place. We are able to arrange support quickly to avoid readmission.

Our next challenge is to audit the success of the Hub. We have already received positive feedback from patients who have found the service incredibly useful, enabling them to arrange the support they need for themselves. In time we will be able to assess emergency admissions and we hope to see a downward trend as a direct result of improved community support.

From our patients’ perspective, the mere fact that there is recognition of the difficulty experienced by those who are socially isolated is invaluable. Small, simple initiatives can make a huge impact on lives.

We are being asked to extend to other areas in Essex and I have been invited to planning and commissioning meetings to share my exoerience.

This is very encouraging, and hopefully will be the way forward in improving Community Care!

REFERENCE

1. Mid-Essex Clinical Commissioning Group. 100-Day Challenge

http://midessexccg.nhs.uk/news-events/88-100-day-challenge