There is a growing recognition among UK policymakers that a person’s health is not simply determined by their medical status. Fulfilment of social, emotional and practical needs also play a role in helping a person to be fully active and engaged in society; these requirements, which are of a personal nature, cannot be solved by a slip of green paper taken to the chemist. These needs are increasingly being regarded not as optional “extras” but factors intrinsic to a happy, healthy, and productive life.
Social prescribing is a means of enabling healthcare professionals to refer patients to non-clinical services that can help meet such needs. The rationale for this approach derives from the strong evidence base that demonstrates how health outcomes are socially determined, i.e. heavily influenced by the conditions in which people are born, grow, live and age (the ‘social determinants of health’). GPs (or other frontline healthcare professionals) can refer patients to a Link Worker, who will work with them to design a package of services or activities to meet their needs. These services vary widely, and potentially include sports, leisure and art activities, or interventions that focus on skills development or education.
But should social prescribing feed into efforts to get individuals with complex needs into employment? On the face of it, this would seem logical; many long-term unemployed people have multiple needs, often including healthcare issues, problems with housing, and low confidence and self-belief. It is harder to find, or stay in work, if – on top of health issues – you do not have supportive networks, lack the confidence enough to navigate a daunting job application process, and have a low level of literacy. It seems likely, therefore, that a holistic, ‘whole-person’ approach to employment support could meet these complex needs and, in turn, be more likely to produce a positive outcome for the patient.
Recognition of this approach can be seen in the recent Government Green Paper ‘Improving Lives’, which set out proposals to tackle the persistent ‘disability employment gap’ (i.e. that the proportion of people with disabilities or a health condition in employment is around 40 percentage points lower than the rate of those without any such condition) within the UK. One of the paper’s core principles is that work is a social determinant of health; meaning that existing evidence suggests being in work is associated with improved mental and physical health, compared to unemployment. The Work Foundation endorses and promotes this principle, providing the work in question is ‘good work’ (i.e. work that is fulfilling, appropriately rewarded, and allows for a level of personal autonomy/control) as this has been shown to have health benefits.
New research by the Work Foundation, launched today, considers whether social prescribing would work as an effective pathway into employment. Social prescribing for work outcomes can be viewed either as a direct route to work by referral to community-based employment support, or an indirect route via a range of community activities which build self-confidence, self-efficacy and social networks. Our work shows encouraging signs that social prescribing has the potential to be an effective means of providing support to achieve work-related outcomes, and fit within a package of care, but existing organisations using the approach do not exploit this area to its full potential.
Our research also suggests that if work is better built in to the social prescribing model (for instance, by including earlier discussions of work and driving development of good quality employment services) then there is potential for the technique to assist the hardest to help to find work. Taking a person-centred approach, instead of trying to “fix” one area at a time, could lead to health and wellbeing benefits that mean an individual can more easily find and maintain employment. However, it is important to note that our research categorically does not recommend that social prescribing techniques become mandatory for those on welfare-to-work schemes; social prescribing “medicines” are co-produced between patients and their key workers, meaning that any effective “treatment” relies on the motivation of the patient to undertake the prescribed action. Social prescribing works with people to understand their needs and goals, empowering them to make choices to help them achieve their aims; a lack of personal drive may render the technique ineffective, due to reluctance and mistrust, and, most probably, a lack of engagement. Therefore it is unlikely that social prescribing could be compatible within the current welfare system, as becoming mandated to undergo an activity can hardly be described as ‘empowering’.
Going forward, support for those seeking work should be holistic. Councils, voluntary sector organisations and the Government are waking up to the realisation that, in order to help people find work, their other needs must be fulfilled; the need for a safe home, social networks, and self-confidence. Indeed, ‘Improving Lives’ states the need for “better [integrated] occupational health type support with other services to ensure more holistic patient care”, and highlights a public service hub in Tameside that directs its users to a variety of services as a “ground breaking response” to supporting people with complex needs. Social prescribing can play an important role in this holistic approach by helping to develop jobseekers’ confidence, self-belief, and wellbeing. The future of welfare-to-work and health support for those with complex needs must move away from simply rehashing medical interventions and towards viewing the person as a whole, helping them in multiple aspects of their lives, and discarding the old and narrow definitions of what constitutes someone’s “health”.