Presentation by Janet Wheatley,VAR
Minutes:
Janet Wheatley, Chief Executive, Voluntary Action Rotherham, gave the following powerpoint presentation:-
Rotherham Social Prescribing
- Sits alongside clinical interventions – helps people live their lives in a way that feels like living rather than coping and surviving. It provides an integrated response to patient care
- Where the NHS ‘meets’ the community and its assets – shifting the focus from conditions or ages to localities and communities
- ‘what matters to me’ as well as ‘what is a matter with me’
- Involved a leap of faith to working differently – there had to be another dimension to meeting patient needs
- Co-produced – between Rotherham CCG, VCS and service users
- Builds on/enhances local relationships, respect and trust between public sector and voluntary and community sector partners
- Flexible to meet changing needs – embedded within CCT and STP
- Supports and resources VCS – works with groups and patients
- Independent evaluation base – evaluated from onset
The ‘Rotherham Model’
- Voluntary Action Rotherham (VAR) on behalf of Rotherham CCG delivers 2 Social Prescribing (SPS) programmes. VAR manages the programme and micro-commissions activity from the VCS – contracts/spot purchases/grants
- LTC SPS works with all GP practices as part of integrated case management approach. Referral pathway identifies patients referred to a VCS advisor aligned to each GP practice. Started 2012 – 5,835 referrals
- Mental Health SPS works with 2 cluster groups of patients referred by RDaSH to a VCS advisor. Operating since 2014 – 328 referrals
- Patients/service users build and direct their own packages of support, tailored to their specific needs by encouraging them to access services provided by the VCS
Rotherham SPS Research
- We have a rich and systematic evidence base to support our work – both schemes have been independently, academically evaluated from the start
- The evaluations track two main elements:-
Improvement in wellbeing and quality of life
Impact on services either in reduction in demand or potential for discharge/step down
- Plus patients/users stories through case studies
Research Findings
- Health and wellbeing – consistently large improvements in wellbeing for all patients/service users referred. Over 80% improvement for LTC patients and over 90% for MH service users
- Reduction in demand for services – for the LTC service consistent reductions in use of services 6-11% reduction in non-elective inpatient stays and 13-17% reduction in use of A&E services – more detailed analysis shows higher reductions in certain types of patients. For the MHS over 50% discharge from services for those eligible for discharge review
- Financial savings – the above evidence translates into definitive cost avoidance savings for the NHS
Additional Research Findings – Impact on Primary Care
Latest evaluation looks at impact from a GP perspective
- Face to face appointments reduced 28%/telephone consultations reduced 14% (tracked in 1 GP practice)
- Opportunity for holistic response to patient care. A person centred service especially for those with complex needs
- Helps patients manage symptoms. Some impact on medication usage
- Rotherham SPS also supports carers – helps with family and care breakdown
Additional Research Findings – Impact – Voluntary/Community Sector
- SPS is a route into delivering a community asset based approach to health – connects, through a single gateway, voluntary and small community groups into wider healthcare delivery. It taps into the potential out there in communities and within individuals
- It supports the VCS to deliver options and solutions to people’s needs. Rotherham’s model provides funding to front line VCS organisations. It is a resourced intervention rather than just signposting to already overstretched VCS services
- We work with VCS groups alongside SPS users – help secure additional funding, volunteers, diversify income, new activities, increase citizen engagement/independence/resilience. It helps rather hinders VCS sustainability
Essential Lessons Learned
- Be clear about the outcomes/target population and clarity on the model – is it SPS ‘lite’ or intensive/signposting or prescription
- Keep the model and referral mechanisms simple – single gateway
- Keep it local – knowledge and expertise out there from local VCS. The perils and benefits of scaling up
- Role of link workers/advisors – linked to practices/localities part of MDT team – build the relationships and combine expertise
- Importance of patient/user to be in charge/have responsibility for their care – do not overcomplicate some of the solutions
- Resource the sector to deliver the solutions – this will enable them to come up with further sustainable options
- Evidence base – what target needs are and what works
- 3 Rs – Relationship, Research, Resources
Rotherham’s Success Story
- The Rotherham SPS model is seen as leading the way across England in the delivery of SPS. Praised in NHS Five Year Forward View
- We have been visited/visit over 120 different areas across England and Wales. We receive 2/3 enquiries monthly about our work
- We have presented at numerous conferences including Kings Fund major conference, met with the Secretary of State, attended a launch at the Home of Commons and won awards
- We anticipate a roll out of SPS nationally and we believe Rotherham will be asked to be at the forefront of it
SPS where next – National/Regional/Local
- Nationally – announcements on a national rollout of SPS are due
- Regionally via STP – inclusion in the Place Plans and STP workstreams. Also link between SPS and the Work and Health programme
- Locally – potential to target other cohorts e.g.
Isolated and lonely/vulnerable/socially excluded/disadvantages – linked to MECC
People with mild to moderate mental health conditions
People with health related employment issues e.g. MSK/Mental Health – linked to work and health
Certain health conditions – e.g. cancer patients/Diabetes or a specific community/locality based approach
Children and young people
Discussion ensued with the following issues raised/clarified:-
· Social Prescribing was not available to everyone. There was an ‘at risk’ register of intensive users of services
· £1M of identified benefits and thought that the GP benefits was understated – the social benefit had not been identified as yet
· This cohort of patients were the ones that medicines were not working for
· Opportunity to explore how it might work with children and families
· Ongoing discussions as to whether the resources could be utilised for those in mental health crisis and linking into prevention of suicides
Resolved:- That the presentation be noted.