Most of the conversation about ending hallway health care in Ontario has focused on the back door of the hospital – moving people out of hospital and back into communities. But what if we could focus on the front door and prevent hospitalization in the first place? And what if we could do this by strengthening partnerships between health and social services, which are known to impact determinants of health? This is a top ten recommendation of both the Premier’s Council on Improving Healthcare and Ending Hallway Medicine and the primary care virtual community’s list of high impact action items for healthcare transformation.
With the new rollout of the Ontario Health Teams (OHTs), there is an opportunity to do this by weaving social prescribing into the tapestry of our healthcare system. Social prescribing is model of care coordination at the crossroads between health care and social services. Social prescribing helps people get connected to social and community services for their “non-health issues,” from social isolation and loneliness to physical activity, food security and housing. In the process, it frees up valuable clinician time and resources by addressing social needs and moving people’s care a step upstream.
A new Commonwealth Fund survey shows that although 60 per cent of family doctors in Canada screen their patients for social needs, only 36 per cent know about the various social services available in their community. Social prescribing enables clinicians to access the support of a link worker – a combination of care coordinator, community developer, and peer support worker. Their role is to know the assets available in the community, to listen deeply to both the needs and the potential contributions of each person (patient), and to co-design and support a person’s social care plan. The link worker helps the healthcare team move beyond asking participants “what’s the matter with you?” to asking – and supporting – “what matters to you?”
The answer could range from help navigating social services and housing forms, connecting to various social or support groups like gardening groups and walking clubs, accessing poverty and food security services, or engaging in local arts and cultural offerings. The goal is to improve wellbeing by de-medicalizing care for those who don’t know where else to turn, beyond their doctor’s office or local ER, when they are feeling lonely, are coping with marginalization, or when something goes wrong in their lives. And social prescribing could prevent or reduce reliance on expensive medical interventions if fundamental needs (like food security) remain unmet.
Social prescribing is gaining traction in integrated health care systems worldwide. The UK’s National Health Service (NHS), even during a time of government austerity, has bet the farm on social prescribing as a key pillar of personalized and integrated care. In 2019, the NHS invested in its first 1,000 new social prescribing link workers across the country – the equivalent of one for every would-be OHT.
In Singapore, rehabilitation hospitals are leading the way in social prescribing, while in Australia physicians and healthcare consumers are teaming up to put social prescribing in the country’s first 10-year health plan. In the US, organizations, such as Kaiser Permanente and the Connecticut Hospital Association have also begun to partner with software developers and community organizations, like 211 and the United Way, to better connect health and social services in accountable care networks similar to OHTs.
Ontario is also poised and ready to scale up social prescribing, and the primary care community is on board. Here in Ontario, the Alliance for Healthier Communities has been piloting a social prescribing project over the last year called Rx:Community, operating in eleven community health centres. Building on the success of this implementation research pilot, and with a modest investment of less than $20 million, the province could install its first social prescribing link workers in this next budget – one for every primary care team in the province – or move former community care access centre and local health integration network care coordinators into primary care to support social prescribing.
With the rollout of the OHTs – and the parallel transformations of public health and emergency services – the Ontario government is investing in a transformation of the entire health system. The mandate of the OHTs call for more efficient coordination of care amongst providers and better connection between patients and their communities. This is a major opportunity for all health and social organizations to move the needle forward on social health and wellbeing together. The OHT application, for example, asks how teams will deliver social and community services (including municipal services), health promotion and disease prevention, community support services, and mental health and addictions resources.
Social prescribing can address hallway healthcare: emerging evidence from the UK shows social prescribing has reduced admissions to hospital emergency departments by up to 24 per cent. It can also help address growing pressures for mental health services: big data analyses of longitudinal data from the UK show simple interventions can have dramatic effects. For example, taking up a hobby made people 272 per cent more likely to recover from depression; regular cultural engagement lowered the odds of developing depression by 48 per cent and reduced the risk of developing a physical disability by 20 per cent.
For those awaiting made-in-Ontario evidence before considering a scale up of social prescribing, the implementation research pilot now wrapping up in eleven Ontario community health centres offers strong promise: after just a year, 90 per cent of participating physicians say social prescribing has improved their clients’ health and wellbeing. Participants report strong improvements in experience and outcome measures including better sense of belonging and confidence in their ability to self-manage health conditions. Electronic medical records are tracking journeys, outcomes and care utilization while feeding this information back to health care providers and clients in a learning health system aimed at improving quality of care.
We know that 80 to 90 per cent of our health and wellbeing is determined by factors outside the mainstream health system. But for years, health care providers have struggled to figure out how to make a dent on structures and policies that are outside their direct control. Social prescribing empowers clinicians, teams, participants and community providers to collaborate and co-design care plans that take this 80 to 90 per cent into account. Scaling up social prescribing would need government buy-in and plenty of leg work in mapping a community’s assets. But the support is there, and this moment of healthcare integration through OHTs is the best opportunity we have had in years to address social determinants of health on a grand scale.
Call it social care coordination or call it social prescribing, let’s not miss this window to build social prescribing into the foundation of our transforming healthcare system.