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31.03.17

Social prescribing: can it be better used as a pathway to work?

Source: NHe Mar/Apr 17

Karen Steadman, research and policy manager at the Work Foundation, part of Lancaster University, explains why work should play a more central role in social prescribing services.

Health is influenced by a wide range of factors. We know smoking, diet or genetics play a considerable role, we also know that other things exert a major influence, including the conditions in which people live and work. 

GPs in England report spending as much as one-fifth of their time on social issues which are not principally about health. This might include welfare, isolation, debt, housing problems or indeed, as is frequently the case, issues relating to work or unemployment. Stretched GPs do not have time nor often the specialist knowledge required to provide patients with constructive guidance or support regarding such issues – often leaving them unable to help their patients. 

Social prescribing offers a way for GPs to refer patients to this specialist support. It recognises that improving health is not always about medicine, instead offering a means of linking patients to a range of non-medical, social support. By taking the time to explore patient needs, ‘link workers’ identify opportunities and link clients into community groups and activities through which social networks are built and confidence improved. They may also be provided with support for specific challenges they are facing, such as housing, debt or welfare advice, or indeed to address other life goals, such as work. 

Work is often viewed as a recovery goal, a marker of a return to normal life. More than just an income it can provide status, social networks and a sense of purpose. Engaging someone with good-quality work has been linked to sustainable health benefits, preventing worsening health and reducing health service use. However, though many people with long-term conditions and disabilities want to work, they find themselves unable to for a range of reasons. This may include functional factors relating to their health, but also often a range of social and psychological issues, including inflexible employers and low confidence. 

Our new study on social prescribing and work revealed that employment is often important for clients. A poll of social prescribing network members identified ‘achieving or moving closer to work’ as the fifth most common goal set by their clients. Many network members were confident in the importance of work, with 70% agreeing that employability and work-related outcomes should be included in the specifications of social prescribing services, given the role that meaningful work has in reducing social isolation, improving self-confidence and self-esteem, and its relationship to health and wellbeing. 

However, social prescribing services are not fully supporting people currently with their work aspirations. Indeed, they may be missing an important opportunity to support people to achieve goals around work. Case studies found that work was not high on the agenda for service providers, or indeed for commissioners, with work outcomes rarely being measured. 

We identified two major obstacles to the better recognition of work within social prescribing: firstly, there is a lack of good-quality employment support available in the community; and secondly, there is a lack of understanding among some healthcare professionals, commissioners and service providers of the potential value of work for people’s health and wellbeing. Many view work as something that can only be broached ‘later’ after someone’s health has improved. If they do not recognise the value of work, they will not commission services to support it. 

The elephant in the room is that not all work is good for health. Work that is of low quality – where people have little control and autonomy, are not fairly rewarded, nor supported – can be bad for health, and particularly for psychological health. Work is not a panacea and, as such, this creates a paradox which some healthcare professionals find uncomfortable, particularly in the context of a welfare system that includes conditionality. Social prescribing is a person-centred approach, with support driven by people’s goals. It is not about foisting work upon people, but instead being positive about work should it be something someone wants to achieve, and empowering them to achieve this ambition. 

The recent consultation on the Work, Health and Disability Green Paper asked what can be done to improve recognition of work as an outcome of healthcare, opening up a conversation about how to shift the way healthcare professionals and the health system sees ‘work’ and how to better support conversations about work with patients. 

This is also part of broader conversations about integrated health and social care, better working with the community, and shifting the focus towards health promotion with the patient at the centre. 

We believe that in this context work, as a social determinant of health and a goal for many clients, should play a more central role in social prescribing services, and action should be taken to improve the ability of the community to support such aspirations, from the moment a patient is referred to these services.

For more information

The ‘Social prescribing: a pathway to work?’ report can be accessed at:

W: www.theworkfoundation.com/reports/social-prescribing-pathway-work/

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