'Self-care' is it a buzz word or a priority topic for our health & care industry? This week's annual Self Care Health Awareness Week, running 13-19 November, certainly suggests the latter. The week focuses on embedding support for self-care across communities, families and generations. Much support is already out there, including some innovative and exciting projects around conversational and digital support. Chief Executive of Care City, John Craig, reflects on this and the work Care City are doing in this field, with reflection from Matt Jameson Evans, Chief Medical Officer at health tech company, HealthUnlocked.
Social prescribing has long been called an idea that can transform the NHS. But social prescribing has been with us for twenty years, and remains at the margins. For every lonely, vulnerable person connected to a reminiscence class or choir, countless others are prescribed anti-depressants. But a new approach offers the chance to change that.
The economist, William Baumol, reflected that performing a Beethoven string quartet would never get more efficient. It can't be leaned into a quicker tempo, or restructured into a trio. We have an aesthetic relationship to Beethoven – how it works is part of what we value.
We don't generally feel this way about the NHS. If there's a quicker, better heart surgery, so much the better. But with the most human, social elements of our service, sometimes we do feel very particular about exactly how they work. Sometimes that's right – vitally important – and sometimes it holds us back.
Care City has been looking at a good example – social prescribing. We think two things are missing from social prescribing: The process could be easier and the evidence could be stronger. To fill these gaps, Care City is working with HealthUnlocked, the world's largest social network for health, providing online peer support for people with long-term conditions. If clinicians had social prescribing data at their fingertips – within the patient record - and could share it with patients at the touch of a button, the process would be quicker. If data about social prescribing was held within that record, the evidence base could be strengthened.
Building on these insights, HealthUnlocked worked with EMIS to integrate social prescribing into the GP record. Through Care City, the system goes live at the first practice in Barking & Dagenham this month, and soon it will be in ten practices locally. We hope it will reach very many more.
One response to this approach to social prescribing is it doesn't sound very social. Partly, that's because connecting patients to walking groups is inspiring and digital infrastructure is not (we need both). Partly also, making social prescribing a two-minute job compromises its appeal.
At its best, a social prescription is a life-changing moment, the product of a long, deep conversation that surfaces people's strengths, interests and personal goals.
But in expensive private healthcare, medication reviews look like that too. We should not allow a premium model of conversation to make social prescribing so expensive that most never experience it. Make it quick and simple and empower people with information about their condition and their community, and they will find great conversation for themselves. Indeed, the evidence about informed, 'activated' patients shows that the first, most basic steps are the most important. The savings for the system are in ensuring as many patients as possible understand the fundamentals. There's no reason why an infrastructure that enables conversational support at scale shouldn't be compared side by side with medical interventions in terms of the value it offers patients.
Matt Jameson Evans is Chief Medical Officer and co founder of HealthUnlocked: "There is a paradox when it comes to scaling up non-medical support: while 87% of local GP's we surveyed said they would refer more patients to peer support if there was an easy way to do so, only 3% had anything other than leaflets or printouts to offer patients living with chronic diseases."
The company have been trading their social prescription tool for about 12 months now. It directly builds on their social network offering, which has over 700 different online health communities across 20 conditions, for people to come to. He added: "Independent evidence shows that once patients can access other patients online, it translates into a measurable change in knowledge, skills and confidence, which in turn link to improved outcomes across most chronic diseases. In our view there is no reason why a technology that enables conversational support at scale shouldn't be compared side by side with medical interventions in terms of the outcomes generated for patients."
If we consider social prescribing this way: we are spending over a billion pounds enabling GP's to get drugs and devices to their patients. The next step must be to deliver the infrastructure to help them deliver this information virtually.
There is a debate about the merits of medical and social models of health, which will continue. In the meantime, there are simple steps we can take to save the system money and grow the knowledge and networks of millions of patients.