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How we set up a social prescribing service during lockdown

As in many areas, the Social Prescribing Link Worker role is new in Lytham St Anne’s Primary Care Network. Two link workers were employed in March 2020, and in the midst of us learning the role, the country almost immediately went into lockdown due to the COVID-19 pandemic.

Working from home with restrictions on face-to-face meetings had an impact on the way we were able to reach patients, and the closure of local groups made it increasingly difficult to carry out the usual objectives of this kind of role.

Like many areas, Lytham St Anne’s saw an incredible response from local volunteers who were keen to help their neighbours, particularly the elderly, vulnerable and those advised to shield by the government.

We had access to the list of shielding patients and worked alongside primary care colleagues to contact each of these patients by telephone for a supportive chat, finding out what additional needs they may have during lockdown. For those that needed help with shopping, collecting medications or dog walking, we were able to signpost or refer to local mutual aid volunteer groups, as well as to NHS volunteers.

For patients who were found to be especially isolated or lonely, or struggling with their mental health, we provided regular check-up calls, in addition to signposting to telephone befriending services.

We found that patients were appreciative of the calls, even if they had no additional needs; they were grateful that they hadn’t been forgotten. Others chose to receive a weekly wellbeing call from us and reported that this helped them to get through the difficult months of lockdown.

Inevitably, a major challenge of this period has been the lack of active community groups and services to prescribe to patients. While some groups have gone online to hold virtual meetings, the large elderly population in Lytham St Anne’s faced barriers to accessing these groups. Age UK Lancashire provided tablets on loan to people who were without the relevant technology and there were volunteers available to teach people how to access apps such as Facetime or Zoom. Despite this, many patients proved to be reluctant to make the move online, and others do not have access to the internet at all. Furthermore, we found that many local groups did not create an online presence, and have simply been waiting to be allowed to meet again in person.

One prominent local group, Just Good Friends, usually provides regular meetings including dancing, quizzes, musical entertainment and exercise sessions. During lockdown, the group leaders kept in touch with their members via telephone and once guidelines lifted to allow people to meet outdoors in small groups, members began to meet in a local park in socially distanced “pods” of up to six. They have recently started some chair-based exercise sessions in the same pods. We have been able to refer new members to this group.

Although groups and services have been restricted during the pandemic, we have been able to build relationships with local group leaders, establishing a good network of contacts which will be invaluable as the community comes to terms with the “new normal”. We have also started seeing some patients for face-to-face appointments and hope to see more and more groups opening up following lockdown, depending on further restrictions that may arise. Drawing from our learning and the need to work more across sectors, we are looking at developing a local Social Prescribing Network in Lytham.

Sign up for our virtual Transforming Healthcare Together Conference to hear more stories about cross-sector partnership working during Covid. We’ll hear from some amazing speakers who will offer local, national and system perspectives.

6 reflections on collaboration during Covid-19

Since April, over 70 leaders from healthcare, VCSE and local authorities have joined IVAR and SEUK-run peer support groups, sharing experiences and thoughts on cross-sector partnership working in healthcare settings during the pandemic. Last week, we hosted the fourth meeting in this series. Here we discuss the current challenges and pressures highlighted by those attending.

1. Identifying priorities for the next six months

The participants listed a focus on recovery as top of the list. Many said that the response to the pandemic has improved relationships across sectors and meant that planning is now a more collaborative process than it was before.

We’ve worked more in partnership with our counterparts than before.’


‘These last three months have been about relationships and communications and we’d like to keep it this way and focus on making this our new normal for the next 6 to 12 months.’

A social prescribing professional was concerned that their services might be used in the wrong way, or be seen as a solution to a different problem if they weren’t very clear ‘who they are for but also trying to increase the referrals and to make it possible for community groups to refer to social prescribing’.


2. Addressing health inequalities and the digital challenge

The switch to digital and virtual healthcare support has made stark the impact for those without access to digital access. One participant spoke about how they have been contacting local community networks and the voluntary sector to reach those left behind by the digital divide. This has led to good relationships being built: ‘It is important to join up with these networks and have conversations and partnerships with them, when you are trying to respond to a crisis like Covid-19’.

 

Secondly with the amount of support being provided in this way, many organisations and services had introduced new, more frequent ways of engaging with users. Whilst this has been welcomed by users, it has become overwhelming and exhausting for providers. Organisations are assessing how to continue to work this way and how to balance this with face-to-face support.  

 

3. Supporting not squashing local community action

Many were keen to support the new micro/hyper local groups and mutual aid systems that have emerged as a huge source of community strength and cohesion over the last few months. At the same time, they are aware of the potentially negative impact on drive and reach that can be caused by over control of local voluntary service councils or ‘professionalisation’.

 

Wirral CVS was able to share some excellent examples of the approach they had taken to supporting local mutual aid groups. Including connecting with groups, but standing back and only offering advice and support when needed. 

 

4. Finding time and space to assess impact

 

Working at pace and re-designing services at speed to support users has meant evaluation and assessing impact hasn’t been at the forefront of many people’s minds. Many commissioners and funders had responded to the emergency by reducing reporting requirements for funded services and organisations. One participant explained they are not thinking about impact yet, being still in the response phase, but are starting to look at recovery and realise that it’s going to be tough.

We are having to fight fires while watching our house burning down.’

At the moment it seems like local charities are just making an impact with the hope that they can assess it at a later stage. However, there is increasing demand from NHS England and NHS Improvement and others to understand what has worked and what systems and new ways of working would be helpful to adopt and retained in a recovery phase.

5. Recording impact with qualitative data and stories

A social prescriber described how she had been encouraging her colleagues to write up the case studies and stories of people they have been supporting during Covid-19 as a way of keeping the individuals at the centre of thinking, both for them and their commissioners. This approach struck a chord with the webinar group, along with the impact of simply documenting what has, and is, taking place. What is ‘normal’ is changing on a daily basis. It was noted how important it is to document this, to capture the new ways of working and support arguments for not slipping back into previous less successful approaches, systems and relationships. Furthermore, some commissioner’s mindsets are changing and becoming more open to hearing individual case studies and patient’s experiences.

 

‘Our commissioners have actually said that they want to hear more case studies than statistics! So, our quarterly reports now have a reasonable amount of case studies and I think commissioners are seeing this as the way forward.’

 

One CCG has a slot for ‘patient voice/experience’ at board meetings and sees the current digital transformation as a valuable as a way of engaging more people with the meetings in order to hear more directly from those experiencing care.

 

It feels like progress is being made if these reflective practices are being adopted more widely and those with lived experience of conditions and care are being put at the centre of decisions and planning. 

 

6. The challenges on the horizon

 

It is worth noting that these conversations and discussions are taking place against a backdrop of uncertainty particularly in statutory sector funding. Many local authorities are nearing bankruptcy making it difficult for them to support anything other than essential services and the NHS will not be able to ‘reset’ back to pre-Covid-19 levels of service and care quickly. It is increasingly important that local areas and their communities are able to leverage the full extent of their local assets, knowledge and experience through collaboration across the sectors.

If you would like to access support for cross-sector partnership in health and care: 

 

  • The next and final peer support session will take place in September 2020. Email nancy.towers@socialenterprise.org.uk to register your interest. 
  • The Building Health Partnership’s programme will host a virtual national conference, sharing best practice and developing relationships in the late Autumn, email vanessa@ivar.org.uk to register your interest.
  • You can register for a 1-2-1 coaching session with Mark Doughty from The King’s Fund here

5 things that help system leaders ‘have difficult conversations’

In order to change the culture within a health and care system, health, voluntary, community and social enterprise sectors (VCSE) leaders need to be open-minded, build on the diversity of people around them and have conversations that are engaging and curious, rather than sparking debate. However, the very nature of developing creative partnerships aiming to disrupt the status quo means that from time-to-time it is likely you will need to have a difficult conversation with someone. So, it is no surprise that delegates at our BHP leadership workshops – attended by health and VCSE sector leaders working to re-shape their local health and care systems – regularly raise the question ‘how do I handle tricky conversations?’  

Here are the five things we suggest will help:

 

  1. Ask the right questions (appreciative inquiry): Leaders must aim to have instrumental conversations and employ the practice of asking constructive and open-ended questions that help to identify a positive core among the group. You can then use the responses as a basis for building meaningful strategies for change. 
  2. Start a dialogue, not a debate: A debate assumes there is only one right answer (the one you have), tries to prove others wrong, defends assumptions as truth and seeks closure around personal views; whereas a dialogue assumes that many people are a part of the answer and fosters an environment of collaboration with others to find common understanding. Through meaningful dialogue, a system leader can listen to understand and seek agreement; and discover multiple options from others in the system. 
  3. Manage polarities in partnership working: System leaders operate in complex environments, and most challenges they face are not problems, but rather dilemmas or polarities. Problems have an end-point, are solvable and use either-or thinking, whereas polarities are ongoing, unsolvable, have interdependent solutions that must be managed together. They require ‘both and’ thinking. So, the next time you are faced with a polarity, ask ‘how do we ensure we access the best of both while avoiding as much of the negative as possible?’ 
  4. Avoid unconscious bias: Be aware of generalisations and understand that we don’t see things as they are, rather we see them as we have been conditioned to see them. We as leaders must openly and continuously challenge our decision-making in our respective systems and organisations, to work towards better and more inclusive conversations. 
  5. Make time to reflect: Making time to be self-reflective, before and after difficult conversations, helps in the long-term.

“I learnt the need to be more self-aware.”

“I will use open ended questions regularly and find time to reflect and practice reflexivity”

 

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Building Health Partnerships

Visit www.ivar.org.uk/transforming-together to access free support including:

 

  • Online resource library
  • Workshops and webinars
  • Coaching delivered by The King’s Fund
  • Practice Development Network
  • Practical and individual support

 

We are currently working with four areas for 2019/20. Please get in touch if you are based in one of the following: Bedfordshire, Luton and Milton Keynes; Surrey Heartlands – Guildford and Waverly; Dorset; and North Cumbria.

 

The leadership workshops referred to in this blog were delivered as part of the Building Health Partnerships (BHP) programme by Mark Doughty, The King’s Fund and Helen Garforth, Institute for Voluntary Action Research. They are attended by leaders from health, voluntary, community and social enterprise sectors, help to develop the skills, behaviours, attitudes and resilience that help in being a ‘change agent’.