College of Medicine Chair, Dr Michael Dixon, this week spoke at the Westminster Insight conference on Tackling Loneliness and Social Isolation in Older People. Here is the abridged address he gave on how social prescribing can help to transform the ever-rising statistics on loneliness:
Loneliness increases your risk of dying by over 25 per cent, with the mental and physical aspects of long-term isolation potentially devastating.
Social prescribing is a hugely useful tool in helping to fight that unecessary statistic because it can identify those who are lonely and isolated, provide opportunities for them – let’s call this ‘Human Company Plus’, enable people to overcome the ‘paradox of loneliness’ and, finally, contribute to creating a society where loneliness is less of a problem altogether.
Social prescribing has three elements. A prescriber – often a GP, a link worker – often with motivational training, and, thirdly, a set of interventions to which the link worker can refer the patient or client.
Since last July, NHS England has been providing a link worker in every group of GP practices (called a Primary Care Network) with the ambition that over the next year or two there will be up to three link workers in each.
The link worker in each Primary Care Network has a significant workload of patients referred by GPs and others, who have identified patients that are lonely and isolated. During Covid, this has become a more active process with link workers themselves often case finding from lists of patients such as those who are shielded – who are likely to be at risk of loneliness.
You may well ask how one or two link workers covering a population that may be as large as 50,000 patients can detect all those who are lonely and isolated. The answer in some areas has been to create an army of local volunteers who can extend their reach.
In Mendip, Somerset, for instance, they have created a thousand community connectors who may be taxi drivers, hairdressers, supermarket staff or students, all carrying a badge and who are able to extend the reach of social prescribing to just about everyone in the community – especially the lonely and isolated.
In Ilfracombe, Devon they have created a volunteer care facilitator on every street, who can find out who is lonely and isolated and then connect them to appropriate voluntary support.
In Bexley and elsewhere “Altogether Better” have created over 25,000 volunteer champions attached to GP practices connecting people in a similar way. So, by these means it is possible to create what you might call a “Heineken effect” discovering and connecting all those who are lonely and isolated in each population.
Social prescribing then offers these people what I would call “Human Company Plus”. That is to say often it may be simply a question of providing social interaction such as the company of a volunteer or joining something like the ‘knit and natter’ group that I have in my own GP practice.
Social prescribing can also offer access to a much wider range of activities such as reading, writing, drawing, singing, gardening and drama groups. In this way it provides the recipient with new interests and a new meaning and significance to their life. This may have a profound effect upon their mental and physical health.
For instance, we know that taking up a hobby can increase your chances of overcoming depression threefold. Thus, social prescribing is not just about providing temporary company but also a sustainable solution to isolation and loneliness. The new Academy of Social Prescribing is hoping to add to the range of possible activities and services available through its Thriving Communities initiative, which will provide substantial funding to the volunteer/voluntary sector in every STP.
Providing all these connections and opportunities is crucial but social prescribing goes deeper. It is about inequalities and helping those who need help most. The last Surgeon General of the US, Vivek Murthy, refers to the ‘Paradox of Loneliness’ which describes how those who feel most lonely may, paradoxically, often be those who are most resistant to social approaches and opportunities.
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It has been estimated, for instance, that lonely brains detect social threat twice as fast as unlonely ones. Consequently, the unique strength of the social prescribing link worker is that they can do a ‘deep dive’ into the mind and lives of their clients and formulate a solution only when they thoroughly understand their background, challenges, hopes and beliefs – and this may often involve the link worker accompanying the client to the first few sessions of any new activity.
Fourthly, I think social prescribing also has a vital role as catalyst for creating a community where people are less lonely to begin with. Social link workers often work alongside community builders, whose job is to increase the potential of the local volunteer and voluntary sector. Indeed, some link workers do both jobs. This results in a coming together of the voluntary sector, primary care and the local authority, which can increase local social capital and resilience and thus create a community where there are less lonely people altogether.
“Covid has, if anything, intensified the need and the role of social prescribing… but increasing use of the digital with social distancing has focused on the need to make the digital more available, particularly for the lonely and isolated.”
In St Austell, in Cornwall, they have done this by creating a very user-friendly APP ‘Help at Hand’. In my own town, Cullompton in Devon, we are hoping to bring together children, who want more volunteering opportunities with the elderly and isolated to help them become more digitally connected. Covid, I should add, has also put an unbearable burden on carers, four fifths of whom have seen their load increase and who themselves require support through social prescription.
Finally, Covid has taught us that where social prescribing is already working well, social distancing has, paradoxically, created greater social connection with volunteers emerging from all directions and better recognition of the suffering of the lonely and isolated.
The future challenge of social prescribing, I suggest, will be around how we maintain the enthusiasm and numbers volunteers and the new connections and the goodwill post-Covid. Because social prescribing is on one level a social connection for the lonely and isolated individual, on another, it is a social movement that will become all the more important with an ageing population, creating kinder communities, where the elderly can live full and connected lives.