Shining a Light on Social Prescribing
‘Robust connections,’ ‘collaborative decision-making processes,’ and ‘a large uptake of the same case-management systems’- these are the elements that have led to Lincolnshire having one of the strongest Social Prescribing systems in the UK, says Sarah Paine (Midlands Social Prescribing Consultant). What better place, then, to host an event ‘Shining a Light on Social Prescribing’.
In December 2023, organisers Ben Anderson, Sally Denton, and Robert Dean hosted a day-long symposium at Lincoln Arts Centre to share experiences of Social Prescribing. The event featured a range of Creative Health service-providers and participants from throughout the Midlands and beyond. Audience members and panellists were invited to envisage a future where Social Prescribing continues to develop and flourish, discussing what is needed for this vision to materialise. This article shares some of the highlights of the event.
What Kind of Creative Health Services Are Out There?
The event showcased a range of fantastic Creative Health practitioners who engage with Social Prescribing pathways. This included Designs in Mind, an art studio in Shropshire where people combat their mental health difficulties via creative arts and crafts. Designs In Mind is unique in their service model, as the products that participants make are often sold in stores, helping to mark the artistic activity as purposeful. This contrasts against arts therapy, where the focus is exclusively about exploring mental health. By prioritising the creation of saleable pieces, participants report reduced feelings of burdening the service. Mental health conversations develop organically and when participants feel safe to do so, rather than being a requirement of each session. This approach is supported by nuanced staff roles and organisational structures, showcasing a level of sophistication that has been developed throughout Designs in Mind’s track-record of over 25 years.
Joining them at the event was SoundLINCS, a music making organisation based in Lincoln, who also have over 25 years of experience. SoundLINCS provide trauma-informed care that has a focus on play and silliness as a healing mechanism. They promote re-connection to the body and the expansion of imagination. SoundLINCS discussed their UpBEAT! music and mental health support service, which can be accessed via NHS Social Prescribing. They were accompanied by one of UpBEAT!’s participants, Cat Winter, who stressed the importance of making Social Prescribing available at the point when an individual is ready to embrace it.
Representing dance provisions at the event, were Birmingham-based Linden Dance and Lincolnshire-based Dance Free. Linden Dance champions positivity, individuality, and free expression. At the event they discussed the Social Prescribing work they recently delivered for people living with Functional Neurological Disorder. Dance Free, on the other hand, use dance to promote generalised well-being. They take participants into the forests where freestyle expression is encouraged. Together, these organisations demonstrated the variety of provisions that can be designed from a single art-form.
Also at the event were providers focusing on the benefits of green spaces. One such example was Green Synergy, who make garden space available for hospital patients and community members across Lincoln. Green Synergy engage with decorating and painting activities in their spaces, plan trips to places like Sherwood Forest in Nottingham, and facilitate ‘wellness recovery action planning.’ A unique feature of their provision is that they teach participants how to use plants and herbs from the garden as medicine – thereby supporting both physical and mental health.
The Unique Selling Points of Creative Health Activities
Throughout the event’s discussions a number of unique selling points emerged in relation to activities that centred Creative Health and/or Green Spaces. The most recurring theme was the concept of play - encouraging children and adults, alike, to rid themselves of the limitations imposed upon them by social etiquette and cultural norms. Steph Wild (Northern Roots) explained that these types of activities offer people permission to play in a way they would otherwise struggle to access. Sara McQueen (Linden Dance) added that the type of people that deliver creative provisions are instrumental to this: ‘dancers are all a bit mental … they create a new type of space with new permissions.’
A great example, of how this ‘permission to play’ was important to service-users, came in a discussion about neurodivergent adults; people who had been conditioned to fit into a normative lifestyle despite it disabling them. Linked to this, Victoria Potterton (SoundLINCS) said ‘our outcomes are sexy and warm and human.’ ‘Other services can’t offer that’ she explained, referring to comparable medical provisions. Viewing Creative Health advocates as pioneers, in this regard, she added ‘eventually people will have to listen’.
Another theme that emerged was the ability for Creative Health provisions to improve the on-going confidence of participants. Whilst some may not consider confidence, alone, a health outcome, Charlotte Phillips (Designs in Mind) explained that this is a confidence that participants carry with them beyond the provision’s end date. As a result, it improves their resilience, their wider social engagement, and their long-term mental health. Jayne Howard (NCCH) added ‘Creative Health is not a panacea for everything but it can certainly do a lot - it can give people meaning, and purpose, and agency, and all of those things that we know contribute to helping people take back control.’
The Realities of Delivering a Service via Social Prescribing
In the opening panel of the event, Jayne Howard (NCCH) outlined three key challenges of Social Prescribing. The first: there is not a single, nationally recognisable Social Prescribing system to work with and understand. She commented ‘in Cornwall alone we have about 30 different models for Social Prescribing. It makes it really hard to engage with that - particularly for providers.’ The second challenge that Jayne acknowledged was funding for programmes of work. ‘We know that NHS England has funded Social Prescribing Link Workers and, to date, they have resisted putting money into activities. It means we can't deliver sustainable levels of work.’ Finally, Jayne asked us to consider the complexity of needs that people have, who are now referred to services via Social Prescribing. Specifically, the Creative Health sector are not able to appropriately respond without further training and support.
The ‘practitioners panel’ then added challenges associated with flexible service provision. Namely, health systems and funding bodies usually require predetermined outcomes and processes. This conflicts with the realities of delivering services to those who are vulnerable or carry complex needs. For example, some participants are known to disengage from services where activity is forced within a regular routine. Whereas, when provision is made available in a more flexible arrangement, more users engage, benefit, and commit to ongoing interaction.
Finally, the ‘people panel’ discussed the stigma associated with the term ‘prescribing,’ along with Link Workers from the audience. They noted that the concept of prescribing hobbies and social activities sounded patronising and overly pathologized, causing resistance from many potential participants. It was agreed that this term exists for the benefit of the medical health community, rather than the patients and participants that they serve.
Barriers to Funding for Creative Health Provisions
Another key discussion that emerged during the event was the topic of funding Creative Health provisions. Audience members had many questions about how panellists were able to sustain their work, despite the aforementioned lack of funding to come via Social Prescribing channels. The panellists responded with a series of barriers and opportunities.
The first barrier that was identified was in relation to the need to evidence the benefits of a service. Whilst there is a large evidence base on the benefits of Creative Health already, the rapidly changing priorities and structures of the NHS system prevent artistic practitioners from being able to reliably draw upon familiar sources. Knowing which data to collect in this ever-changing landscape makes it hard for artistic practitioners to engage with evidence collection, using their limited resources.
Added to this, was the issue of how ‘success’ is measured. Artistic and heritage funders were reported to encourage output measures over outcome measures in their funding applications. Here, outputs are quantifiable data, whereas outcomes are more personalised in their nature. Panellists and audience members, alike, felt that this prioritisation risks service-providers focusing on getting numbers through their doors, rather that delivering high-impact sessions. They advocated for evaluation systems that made space for the remarkable shifts that can be catalysed in smaller groups, referring to users who have claimed that without Creative Health services they might not be here.
The final barrier that was discussed was the commissioning bias towards short-term projects over sustainable programmes of work. A key feature of this discussion was the safeguarding of participants. Others commented that the short-term nature of these projects added to an already messy Social Prescribing landscape, thereby decreasing the chances of Link Workers referring participants to Creative Health provisions. Another negative outcome of project-based work is that it prevents the evolution of Creative Health services, with practitioner expertise being lost between projects that are starkly different in their aims.
Funding Opportunities for Creative Health Provisions
Advice on opportunities came from fundraising specialist, Charlotte Phillips (Designs In Mind), who encouraged audience members to be creative in their response to these barriers. A great example is for providers to refer to previous activities, or projects by other people, as a way of demonstrating a track record and evidence-base, then changing the context/target audience to show why this should exist as a project in it’s own right. This strategy helps to manage risk in the provisions being proposed, whilst still providing the novelty associated with project work.
Charlotte also encouraged honesty with numbers – as opposed to being misdirected by the pressure for quantifiable measures. Specifically, being able to recognise the barriers to reaching higher numbers, or the opportunities that were fostered by keeping the numbers lower, helps to develop a healthy relationship with commissioners. Moreover, by being specific about the number of people who engaged per session, rather than only the total number of people engaged, helps commissioners to familiarise themselves with the realities of these services. In other words, Creative Health providers are the experts-by-experience when it comes to how to deliver these provisions, and it is important for their authentic voices to be heard.
Finally, the panel encouraged Creative Health practitioners to credit their own involvement in projects as one of the beneficial outcomes. In this case, the output being measured might be the number of accumulative hours that members of the public have access to an artistic expert. This can be connected to the evidence base on the implicit health and well-being benefits of everyday creativity, which have been shown to have a positive impact on the quality and length of life.
Ways to Positively Develop Social Prescribing
To conclude the event, and this article, speakers and audience members shared their most pertinent ideas of how we need to develop the Social Prescribing system for it to become a sustainable model for Creative Health service delivery. These points are summarised below:
We need to develop consistency in how we track the progress and outcomes of Creative Health provisions.
Social Prescribing case-management systems may have a key part to play in supporting the working capacity of artistic providers when it comes to collating evidence of their service’s benefits.
To make Social Prescribing accessible to users, we need to have a consistent and clear referral process. This will require buy-in from Primary Care stakeholders and unification of case management systems across a single geographical area.
Whilst the Social Prescribing landscape remains messy and complicated, advocates benefit from accessing knowledge-sharing events and networking opportunities. For this to happen, more regional event organisers need to be involved.
Social Media is going to be key to aiding the visibility of Social Prescribing, so that more members of the public are made aware of its existence. The more that this content features real stories and images/videos of participants, the more we can humanise the ‘prescribing’ term.
For Social Prescribing to become normalised as a popular health initiative, it benefits from familiar and catchy phrases. A great comparison is the Five-A-Day rule for fruit and veg, or the ‘Catch it, Bin it, Kill it’ slogan for the prevention of spreading colds and flus.
We must also consider how we engage people who do not have the digital literacy to hear about Social Prescribing online, or who come from cultures who are extra wary of this type of provision. Where panellists have successfully achieved this, they engaged in creative exercises like using the sharing of food to bring people together for information sharing, or collaborating with trusted partners to embed themselves into a community on their own terms.
In addition to these more generalised ideas for progression, NCCH and event organiser, Robert Dean, have specific ways that you can support the progression of Creative Health in Social Prescribing.
For people with lived experience of using a Social Prescribing pathway, or for Creative Health providers who have links to people who were supported through their provision, Robert is conducting a project which seeks to develop video content. These will be audio-visual recordings capturing how people have been positively affected by being prescribed a social provision. He has an ambitious goal of capturing 1,000 stories. You can find out more about Robert and his work here.
For those working as Link Workers or Community Connectors of any kind, we urge you to respond to our Survey on Social Prescribing. This survey, developed by Creative Health Associate, Penny Calvert, seeks to understand how much Social Prescribers comprehend about Creative Health provisions. Your candid answers will provide us with insights on how our team can support the integration of Creative Health into the Social Prescribing system.
Finally, a call to action from our Programme Manager, Jayne Howard. Election season is coming up and it is now more important than ever that we all quiz our local candidates about what their plans are for the health and cultural sectors. Help us put Creative Health on the agendas of multiple parties by contacting your local representatives, advocating for what you think needs to change or develop! For evidence of how creativity can aid health and well-being, you can share our 2023 Creative Health Review Report.