Article updated 21 February 2019
Social work leaders have supported NHS plans to recruit an extra 1,000 health-based workers to prescribe social activities to people, despite frontline concern that such work should be carried out by social care professionals.
Chief social worker for adults Lyn Romeo said the social prescribing link workers would not displace social workers and represented a welcome embrace of the social model of care by the NHS. The move also won the qualified backing of the Adult Principal Social Worker Network.
NHS England last week announced it would fund the recruitment of an extra 1,000 link workers by April 2021 as part of plans to personalise care across the NHS. It said the link workers would help connect patients with community groups and agencies for practical and emotional support for issues, including loneliness, mental health problems and complex social needs.
The policy was set out last week as part of a plan to implement ‘universal personalised care’ across the NHS.
This was published alongside a five-year framework for GP services, which set out that funding for the link workers would be given to primary care networks (PCNs), within which the link workers will be based. PCNs consist of groups of GP practices, serving populations of 30,000 to 50,000, but are expected to also include or have links with community health providers and social care.
Link worker role
All primary care networks (PCN) will be funded in 2019-20 to commission at least one additional social prescribing link worker, based within the network. They will take referrals from members of PCNs and will expand to take referrals from other agencies, including local authorities, in 2020-21. As stated in the framework for GP services, the key role responsibilities of these professionals will be to:
- provide personalised support to individuals, their families and carers to take control of their wellbeing, live independently and improve their health outcomes;
- develop trusting relationships by giving people time and focus on ‘what matters to them’;
- take a holistic approach, based on the person’s priorities, and the wider determinants of health;
- co-produce a simple personalised care and support plan to improve health and wellbeing, introducing or reconnecting people to community groups and statutory services; and
- evaluate the individual impact of a person’s wellness progress.
Link workers will be asked to draw on and increase the strengths and capacities of local communities, enabling local voluntary and community organisations and community groups to receive social prescribing referrals.
They will also ensure those organisations and groups are supported, have basic safeguarding processes for vulnerable individuals and can provide opportunities for the person to develop friendships, a sense of belonging, and build knowledge, skills and confidence.
‘Why not use existing resources and skills?’
Following the announcement some frontline social workers took to Twitter to express their confusion at the announcement, highlighting that they already carried out similar duties and extra workers would be a waste of resources.
I am a #socialworker & this is quite literally my job description. I’m not suggesting others can’t or shouldn’t do this but why not use existing resources, skills and see some return on investment… (In 2011, NHS spent £80 million on bursaries for SWs) #SocialPrescribing https://t.co/0uLKGpiPXh
— girlfrombackthen (@skiffleandrag) 28 January 2019
Each time I hear the words ‘social prescribing’ I think about the abject failure across social care to describe what social care is & make it central to integration.
— Rob Mitchell (@RobMitch92) 28 January 2019
They’re called social workers. They already exist. This thread is.literally part and parcel of the job description.
Also the term social prescribing is icky. https://t.co/7nW93AKV5X
— Nick (@nickinoxford) 29 January 2019
Chief social worker for adults Lyn Romeo defended the policy, saying she was encouraged to see GPs and primary care services adopting a social model-based approach in supporting people, and that social workers would continue to play an important role in connecting people with services.
“Providing opportunities for people to be connected to support earlier, through the use of link workers in GP settings, is the right decision,” she said.
“Social workers, other local authority services, and the community and voluntary sector, have a continued valuable contribution to make in terms of their local knowledge, which enables solutions that blend statutory, community and voluntary services.
Romeo disagreed with suggestions that the decision reflected a reinvention or ‘medicalisation’ of social work.
“This is the opposite of ‘medicalisation’ – it is about drawing in voluntary, community and clinical support and recommending activities and services that are a better alternative to medication.
“Social workers and occupational therapists are already at the heart of these efforts, so it’s positive to see the wider health system beginning to catch on.”
Joined up thinking between sectors
The co-chair of the Adult Principal Social Worker Network, Tricia Pereira, said the recruitment of the extra link workers would “complement” social work and offer people “another route” into finding support.
She emphasised the importance of getting link workers and GPs to think holistically but was encouraged to see more joined-up thinking between the health and social care.
“We are moving to integrated services more and more, and it’s easy to be pessimistic, especially when there are times of austerity, but we have to work in new ways.
“For me, it looks as though [the decision to give health care greater involvement] has the potential to move services back into proper community-based support, if we’re looking at social work and healthcare being able to pool resources and support the individual as they want.”
But Pereira did question who would pay for the social activities, with NHS and social care staff both able to prescribe treatments.
“We all know that health care is free under the NHS, but there’s a cost attached to social care. If this is a cost initiative, it must be clear how funding is going to be arranged, whether the person will have to pay for the activates they are prescribed. If so, will people have the financial means to pay for their prescribed activities?”
Evidence for social prescribing
There are already social prescribing schemes within the health service, with 69,000 people having received a referral in the past 12 months according to NHS England.
An NHS England guide to social prescribing said there was emerging evidence of a positive impact on people’s health and wellbeing, but that more robust and systematic evaluations of impact were needed.
A 2017 British Medical Journal paper, reviewing 15 evaluations of social prescribing programmes, found most presented positive conclusions but all had a high risk of bias, meaning that current evidence failed to provide sufficient detail to judge either success or value for money.
Expanding personal health budgets
The plan for personalised care in the NHS also included proposals to increase the number of personal health budgets (PHBs). Similarly to social care personal budgets, these provide people with long-term conditions with an identified sum to meet their health and wellbeing needs whose spending will be agreed between them and their local clinical commissioning group.
As of September 2018, 32,341 people had a PHB, an increase of 105% over the preceding year, and NHS England said it wanted to see 100,000 in place by 2020-21.
To help achieve this, the government has announced that it will extend the ‘right to have’ a PHB, currently held only by adults receiving continuing healthcare and children receiving continuing care, would be extended to the following groups:
- People eligible for section 117 aftercare services and people of all ages who make regular and ongoing use of community-based mental health services.
- People who access wheelchair services whose postural and mobility needs have an impact on their wider health and social care needs.
This follows a consultation, in which it also asked about extending the right to:
- People with ongoing social care needs who make regular and ongoing use of relevant NHS services.
- People leaving the armed forces who are eligible for ongoing NHS services.
- People with a learning disability, autism or both, who are eligible for NHS care.
In the light of the consultation, the DHSC said it would continue to explore extending the right to these groups.
In addition, NHS England has said PHBs would become the default option for the estimated 20,000 people receiving continuing healthcare (CHC) at home from 1 April 2019.