Jennie Cox is the Senior Local Area Coordinator in York and Christine Marmion is the Project Manager of Ways to Wellbeing, the Social Prescribing service in the city. They came together to address ‘the signposting question’ which they found their teams were frequently encountering….
Jennie: Several months ago I saw a question posed on Twitter by the leader of the Social Care Futures movement – “Social Prescribing, isn’t that just social pointing at stuff?” I was quick to reply that this was definitely not my experience of the model operating in York, reflecting on a positive story of collaboration and relationships I had told with Jasmine Howard, the original Project Lead for Ways to Wellbeing social prescribing service, back in June 2018. I was challenged to write another blog articulating what else there was to Social Prescribing and Local Area Coordination in York which made it so much more than ‘just signposting’ and articulate how they were complimentary without duplicating. In the spirit of co-production, I invited the Project Manager of Ways to Wellbeing to write this with me.
Christine explains the model in York: Social Prescribing models differ across the country and can look very different depending on where you live in the UK. Our model supports individuals who are referred to us by Primary Care health professionals when an individual is accessing their GP’s for non-clinical support. We link people to non-medical support from within the community to promote their mental and physical wellbeing in a holistic way. Ways to Wellbeing support people with a wide range of social, emotional and practical needs, including people with complex health needs, mild or long-term mental health problems or people who are quite simply lonely. We provide appointments in GP surgeries or out in the community. Patient feedback has told us that being embedded in the GP Groups allows patients to feel safe and provides the service with credibility. There is a natural synergy with Local Area Coordinators who are embedded in the wider system. Together we have a lot of agency and reach across the social sector.
Jennie reflects: Social Prescribing is a current buzz phrase which comes with a number of misconceptions. Many people imagine a prescription pad of social solutions, a fixed menu of options, but this is very far from the way that Ways to Wellbeing work. Local Area Coordination suffers from similar misconceptions and visions of LACs sitting with people drinking endless cups of tea and directing them to other places with leaflets and phone numbers. Of course, connecting people to activities, groups and services in the community and providing information and advice about these is a big part of what we all do, however, doing this without providing a supportive framework around this would be somewhat tokenistic. Which is why we offer flexible person centred support to those we work with. This involves being alongside them whilst they explore options to increase their wellbeing and live a good life. We are about relationships, listening, exploring options in a creative way, and helping to create options where very few exist which fit.
Christine adds to this: Collectively, we recognise that social issues can have a significant impact on a person’s physical and mental wellbeing, where there is no health or social care solution. Ways to Wellbeing is a connecting service and we don’t generally work with people long term but we support them to take the first steps to get to where they want to go. A lot of the people we work with need a little help to make what they feel are big changes. For those people struggling with their emotional health or significant life changes it can seem impossible to navigate or achieve the long term positive changes that are required to make a significant difference to their situation. This is where working alongside LACs can work really well as their time spent with a person can be longer term. Whether it is taking someone to a group before the activity starts so they can adjust to the environment or introducing individuals to group leaders, volunteers or other professionals so they feel confident they will know a friendly face. We are able to provide the additional support that is needed to take the first steps and connect. It is not just sign posting but supporting people to make simple changes to their lifestyle to improve independence and quality of life.
Jennie adds: Just signposting would add pressure to an already creaking voluntary and community sector and drain resources without putting anything back, which is definitely not our approach. Community capacity building is an important aspect of the roles of both of our teams. We work together to identify gaps in community provision or barriers to engagement and find ways to overcome them. LACs do this through their connections in the local areas they cover and the wider system which enable them to link people together and encourage better use of resources, for example the sharing of buildings or equipment or encouraging flexibility and adapting of processes through their bottom up system change work. Ways to Wellbeing have developed a small grants fund helping to encourage sustainability of community provision and the development of new initiatives. Both programmes link in to volunteering pathways so people can share their skills and time with others, increasing social action and capital.
Jennie shares some thoughts on questions which arise about duplication: It’s true there are a lot of commonalities between the York LAC and Ways to Wellbeing teams – we are person centred, strengths based, we are accessible by avoiding complicated referral processes and keep an open door rather than treating people like closed cases after a set amount of time or support has been offered. We are informal programmes of support which people enter in to voluntary relationships with which are alongside and are complimentary to formal service provision. We also share values and principles connected to sharing power, choice and control with people who are experts in their own lives.
Christine reflects: Across LAC and Ways to Wellbeing appointments are informal and individuals are allowed to set the agenda and set the pace. We provide time and space to explore what is important to a person, not rushing, acknowledging barriers and finding solutions. We use people’s interests and values to create a person centred plan. We treat people as individuals and do not dictate to them what they should or should not do but provide information and guidance. We promote health responsibility, promote self care and encourage people to take control of their own health and wellbeing where possible.
Jennie adds: There are also some important differences – whereas Ways to Wellbeing are based in GP surgeries and take most of their referrals from GPs in primary care, LACs are more embedded in the wider system and take introductions from anywhere in the system, whilst covering discreet geographical areas as place based practitioners. The LAC is a broad approach which lends itself more to working with people and their families with more complex lives over a longer timeframe. Ways to Wellbeing have more focussed plans to connect individuals and increase wellbeing whilst reducing demand on GPs and health services. Most importantly, when addressing questions about duplication it is helpful to point out there are more than enough people who want help from both programmes and both teams are in high demand. LACs continue to receive an average of five introductions (referrals) a week each and Ways to Wellbeing are operating a waiting list. We see this as indicative that both are needed and complement one another, offering choice, which is a good thing.
Christine adds: The cost of commissioning both programmes is low considering what we offer and the outcomes we have evidenced across our impact and evaluation reports. There have been a number of examples where joined up working between the Ways to Wellbeing Practitioner’s and the LAC’s have led to improved outcomes for the people we work with. Sharing knowledge and sharing information rather than guarding resources has helped with this. In the future we only plan to strengthen these relationships by exploring how we can use a whole system approach to evaluation and data collection.
Jennie summarises: We work together to manage demand and compare notes on where this is coming from, with our monitoring data often acting as a barometer of social need across the city. Our approach to working together is the opposite of silo working – we have sensible conversations about who would be best placed to offer support and no arguments about what is whose remit. Relationships, at all levels, is a common and important thread which we keep coming back to. We are positioned in very different parts of the system, with Ways to Wellbeing hosted by York CVS and LAC based in the Adult Contracts and Commissioning Team of the Local Authority. A large part of our funding comes from the same place, but we make it work and it works well.