Our second network meeting was held on the 16th May 2019 and focussed on the outcomes that we are looking to achieve through social prescribing.
We had Suzanne Moffat and Josephine Wildman (Newcastle University) and Guy Pilkington (Clinical Chair of Newcastle West CCG) come to share their experience working on the Ways to Wellness Social Prescribing project in Newcastle. This was a really helpful presentation giving an overview of their model and the outcomes they have measured. Here’s the powerpoint presentation they gave on the day.
Overview of the Ways to Wellness model:
The programme started in 2015. They had grants of £2m from the Big Lottery and £1m from the Cabinet Office. They also had Social Investment from Bridges of up to £1.65m of which they have drawn about £1m - this is the element with payment back to the investor. So, in effect they have had a heavily subsidised years 1-4 and will have ‘expensive’ years 5-7.
Two providers employ 26 link workers who each work with about 100 people a year. The average length they work with people for is 18-19 months.
18 GP practices (covering a population of 140,000) refer into the service. The referral criteria are that the person has to have a long-term condition (diabetes, chronic obstructive pulmonary disease, asthma, coronary heart disease, heart failure, epilepsy, osteoporosis) and be aged between 40-74. This equates to a cohort of 14,300 people.
They have estimated the cost envelope of the service at £800k per annum.
The average annual hospital cost per patient across the full Ways to Wellness cohort was 7.5% (£86 per head) lower than the comparison cohort last year (2017/18).
Across the full eligible Ways to Wellness cohort (14,300 patients), this difference equates to annual savings of over £1.2 million in 2017/18.
Learnings from Ways to Wellness
- They need to support VCS to measure their social return on investment to understand impact on secondary care
- Impinging on link worker time makes outcome measurement difficult
- Outcomes star really useful as goal setting tool but not a validated outcome measure – they are using EQ5-D instead
- In evaluating the programme they have gained understanding of the importance of long term engagement with the link worker – to support with behavioural change and long term management of conditions
What outcomes should we be measuring in Southwark?
We agreed on a set out outcomes that we should be measuring through social prescribing projects in Southwark. We will be refining these and looking at the most relevant tools to measure these outcomes over the next few months.
- Increased ability to achieve individual goals
- Increased social connectedness
- Reduction in inappropriate GP appointments
- Improved self-management of conditions
- Increased physical activity
- Reduction in non-elected hospital admissions
- Increased confidence
- Reduction in inappropriate medication prescribed particularly for people with mental health needs
- Improved quality of life
- Better control of long term conditions
- Positive changes to vital 5 (high blood pressure, obesity, smoking, alcohol and common mental health conditions)
Here’s the link to the notes setting out the discussions on the outcomes, the challenges and solutions associated with collecting them.
Things to bear in mind...
- We can agree that these outcomes can be measured in different ways by different projects as long as the overarching outcomes are the same (ie they can be tailored to services)
- It is important how we ask these questions – we are not telling people what they should do
- It is important to ensure data collection doesn’t impinge ability for services to be delivered and that funding can flow beyond link worker employers to the groups providing activities
- There are some really good tools that are used to help people set and review goals (e.g. Wellbeing Star); however, these are not considered to be statistically significant or valid when setting outcome measures – particularly if these are to be tied to payment
- Data collection should be proportionate to size of organisation and capacity – having too many tools can be overwhelming
Here’s the presentation that Jane Harris from Cordis Bright gave on the Southwark social prescribing review which highlights the outcomes projects are already measuring and some recommended tools.