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.
Potential conflicts: Dr. Mulligan leads the current social prescribing project of the Alliance for Healthier Communities under a “Health and Wellbeing” grant from Ontario Ministry of Health.
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We need this in the heart and stroke community
Insightful reading. After 72 years of NHS slowly yet surely clinical directors staff nurses, members of new MH peer Coaches UK networks collaborate Across UK health trusts disciplines of social prescribing are pilot schemes. On Thursday I participated in social prescribing initiatives in maternal care at North west london NHS trust. In UK london NHS trust I am involved with clinical staff, board directors as registered patient ambassador service user rep qualified coproduction and MH peer coach/support also I’m Islington resident rep input on North London partnerships (NPL)strategic transformation plan. Early applications of Social prescribing in repeat medications methadone programs show improvements in long term patient engagement and long term health planning. I would appreciate opportunity to access join applying Canadian models into UK NHS work.
Thank you for this article. This message needs to be featured in OHT discussions.
Community Health Centres are already poised to deliver, expand and innovate these to meet local needs.
Stonegate CHC and Rexdale CHC (the two that I know) are both doing great work with the pilot – but it needs to become baked into the regular model.
Also, FUNDING will need to be associated with those prescriptions for activities that cost money.
It moves the needle from a patient focus to a people focus, which is where health should be.
Recreation Therapists need to be added to more community health teams. The profession has been social prescribing for 40+ years and underfunded and under recognized for this important work seen as “non-essential” for too long
I think this is social policy advocacy for the purpose of expanding the alleged importance on health care into other parts of life and for expanding budgets of researchers and health care providers etc.
This is likely to place an ever-increasing strain on health care where people go to ER or a doctor to just chat. Why can’t those folks go to a community center, join a social club, go to church or other religious center, take a class? A doctor writing a prescription to “rent-a-friend” isn’t a cure for loneliness.
I’m replying to myself to cite another Healthdebate article … Shifting resources AWAY from health care … Instead of social prescribing by health professionals, how about prioritizing health care resources, reducing health care spending and compensation to health care professionals, and shifting that to others.
http://healthydebate.ca/opinions/our-hospitals-and-prisons-are-failing-because-were-using-them-to-house-people-instead-of-to-help-them
Adam, I believe that is exactly what this initiative is proposing to do. The unfortunate fact is that currently, we have citizens in our communities using the ER as a place to go when they need a human connection. As our Healthcare system operates now, doctors are expected to attempt to diagnose a reason for the patient’s visit, ruling out any possible pathology before discharging them.
The idea of social prescribing is that there is a layer at triage that catches those who are just there for a visit (as patients), and directs them to appropriate connections. Your second point, about redirecting resources to support some of these other programs, etc., is absolutely valid, but we need the tool in place to filter those who require these programs to them, or the reduction in funding to health care is only going to result in a lower quality of care for all, whether they require medical care or not.
Agree with you. But the power dynamics are that physicians and other health care workers will demand increased resources for themselves (all of whom are well educated mostly middle-upper class people) to perform these functions. These are the people who have access to political resources to influence debate, including here. To what end? I am proposing to shift spending away from health care. That is not a “lower quality of care”. You seem to be stuck in the idea that more spending means better care; more services means better care. That is not true. Can you agree with that?
Good article and good conversation. Thank you to the authors.
My hope is that someday we will go beyond just words and discussions and articles in various fora, and actually DO something about it. Clearly, the best form of healthcare is not just the “sickcare” system. Yes, we need hospitals and physicians and primary care. But we also need a robust wellness care system that includes addressing the social determinants of health. Social prescribing is not just to address those who are sick and need care – a key element of social prescribing is preventative wellness care. True healthcare would be a holistic approach addressing the body, mind, social factors and eco-systems.
I am not sure anyone would strongly argue that this is not the case. And yet, we don’t seem to have the will to back our intelligence and intuition with the investment that is required. I am not sure what more is required for us to make a fundamental shift towards a preventative healthcare system which incorporates social prescribing as a pillar.
Our health care system is run by physicians. This is a problem. We need funding for the broader health care team- social workers, psychologists, dietitians, pharmacists, PT, OT, etc.
That’s an excellent point Phil. For example why is something like this clinic as below, being run as a private clinic that does not receive or rather allow OHIP billing it seems rather than part of the mainstream health care system, when it’s treating actual medical diseases and conditions?
Functional Neurology & Vestibular Rehabilitation Clinic – rehabilitation programs for neurological disorders
http://neurorehabclinics.ca
In order to address social poverty (loneliness, dysfunctional social relationships etc.), we need to bring effective social and health care policies. Building social capital and community cohesion is paramount important for sustainable and effective health care system. We need to bring back our old social values to enhance community solidarity. It is our social responsibility to make this world a better place for all. Research found that health care providers rarely refer patients to local community groups or advice services, due to a lack of up-to-date knowledge of local resources. In order to enhance health and wellbeing of patients, health care providers need to address patients’ medical and psychosocial needs. Studies also found that the patients are not comfortable discussing their non-medical needs with health care providers. It is important that we invest on research to find innovative tools that could facilitate doctor patient conversation on this important health care issue.
Evidence resources and tools for social prescribing- https://www.england.nhs.uk/personalisedcare/social-prescribing/
The problem though is that in an environment where there needs to be robust evidence for the OMHLTC to cover the costs under the provincial health care plan, this doesn’t seem the case, at least for a very “picky”, if you will, environment as we have in Ontario when it comes to funding health care services and technologies ie:
“The impact of social prescribing services on service users: a systematic review of the evidence.” – Eur J Public Health. 2019 Jun 14. pii: ckz078. doi: 10.1093/eurpub/ckz078. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31199436