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Despite some beautiful summer weather in the last few weeks, my colleagues and I are beginning to think about planning for winter.
An address at a conference I attended, that has really influenced my thinking in practice, was delivered by Duncan Selby, Chief Executive of Public Health England. He asked us all—a group of senior nurses from the acute sector—to raise our hands if we worked in health care. We dutifully all raised our hands, at which he told us all that we were wrong, as we all worked in illness, whereas health was about someone's ability to work, for example, to socialise, to go to the hairdressers—not to sit in a hospital bed with illness or injury being nursed by us.
Much has been learnt about the effects of prolonged hospital stays. The national Twitter campaign ‘End PJ Paralysis’ (#pjparalysis) was discussed by Oliver (2017), who reflected that the starting premise of the campaign aimed to encourage healthcare staff, families and patients to get more hospital inpatients out of nightwear, out of bed, and into their day clothes to speed their recovery and help minimise harm from prolonged immobility. Oliver (2017) went on to discuss the importance of this approach, particularly with a rise in an ageing population, and an increase in competing pressures on nursing staff coupled with a variable availability of therapy teams, which means that getting people up, dressed and mobile can fall down the list of priorities.
Last winter, my colleagues and I worked very closely with colleagues from both adult social care and the third sector. This was when I saw Duncan Selby's perspective on ‘health’ really come to life. There were countless examples where I saw how social workers and team members from Age UK worked with individuals and their families to understand what mattered to them, and what would enable them to get home to resume their life. There was such a cultural difference between our risk-based approach in the acute setting, and what colleagues commonly called a ‘strengths-based approach’ focused on the inherent strengths of individuals and their families.
As we work together to consider the health of our local population, I am also learning from colleagues about ‘social prescribing’.The King's Fund (2017) defined social prescribing as:
‘A means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services. Recognising that people's health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address people's needs in a holistic way. It also aims to support individuals to take greater control of their own health.’
The King's Fund highlighted that, although there are a number of different models for social prescribing, many involve a link worker or navigator who works with people to access local sources of support.
The NHS Long-Term Plan (NHS England and NHS Improvement, 2019) has identified that social prescribing and community-based support will deliver the NHS commitment to make personalised care business as usual across the health and care system. Personalised care, as defined in the NHS England (2019) summary guide to social prescribing and community support, means that:
‘People have choice and control over the way their care is planned and delivered, based on ‘what matters’ to them and their individual strengths and needs.’
Personalised care involves a whole-system approach, integrating services around the person, and making the most of ‘the expertise, capacity and potential of people, families and communities’ to deliver better patient experience and outcomes. The evidence base is growing:
‘There is emerging evidence that social prescribing can lead to a range of positive health and wellbeing outcomes for people, such as improved quality of life and emotional wellbeing.’
The guide goes on to say that, although ‘there is a need for more robust and systematic evidence on the effectiveness of social prescribing’, there is optimism that such schemes ‘may lead to a reduction in the use of NHS services, including GP attendance’. According to the Royal College of General Practitioners (2018), 59% of GPs think social prescribing can help reduce their workload.
My experience of working with colleagues from social care has been inspirational. With budgetary and workforce constraints continuing against the backdrop of increased demand for care, our co-produced approach to this winter, using a social prescribing model, may realise the opportunity to improve the health of our population and reduce the long-term care burden by really delivering healthcare to individuals. This has to be preferable to our traditional crisis-reactive short-term approach of opening or buying as many beds as possible.