Oldham Council

Oldham Council

Oldham Social Prescribing Innovation Partnership

Briefly describe the initiative/ project/service; please include your aims and objectives

The Oldham Social Prescribing Innovation Partnership is a pioneering £1.1m three-year programme on behalf of OldhamCares (our integrated care organisation) led by a local consortium of voluntary and community organisations. The commissioning model is one of the first for the public sector in England, drawing power from the social value act to focus on innovating and iterating the service model through coproduction with partners and residents to get the best service and offer possible to meet residents needs.

The consortia of voluntary, community faith and social enterprise (VCFSE) partners includes Action Together (lead), Mind, Age UK, Positive Steps and Altogether Better. It works in partnership with local health and care partners particularly OldhamCares and Oldham Council. The objectives are to; improve the health and wellbeing for people in Oldham through ‘more than medical’ care and support, build upon community capacity, reduce pressure on the health and care system by digitally linking primary care to community capacity. The aim is to develop a social prescribing approach linking residents who have ‘more than medical’ needs e.g. social isolation, loneliness, low level mental health. The model places community development and sustainability at the heart of the work and then links them together digitally with instant online referrals and in the future predicative risk stratification to identify those at risk of escalating into higher levels of need and acting before it happens.

What are the key achievements?

– The Innovation Partnership has brought together existing local organisations in a new partnership, this has created a shared space where they are encouraged to build stronger referral pathways and enable more collaboration by removing competing system or service metrics or targets.
– The social prescribing model has been operating for over 18 months and has supported over 800 people to date, connecting them to local activities such as walking groups, sewing groups or coffee mornings, or helping them navigate other public services such as welfare and housing.
– A care champion model has also been developed, empowering patients to develop their own support networks to tackle physical or mental health conditions using the activities they best respond to e.g. a 10 minute walking group for people with COPD or asthma.
– From the cohort of people supported, early indications show that GP appointments have been reduced by 41% and reductions in accident and emergency attendance are in excess of 85%. Case studies also show that the approach is helping people live healthier happier lives, improve outcomes and enter employment.
– A software system has gone live which digitally links in primary care to community capacity and all Oldham social prescribing partners. Allowing GP’s to link into community capacity within 3 clicks and live MI of the thousands of people using social prescribing every year and the outcomes they are achieving a digitised version of the Warwick Edinburgh Wellbeing Scale

What are the key learning points?

The Oldham Social Prescribing model places community development and sustainability at the heart of the work. There is community development capacity built into the model which is vital to understanding what is happening in communities to connect people to, and to ensuring local groups are in a position to include more people. The strengths based approach of the innovation partnership is also key to the success, putting social value at the heart and building on the skills, knowledge, experience and relationships of partners already delivering successfully in Oldham. The governance takes a more equal footing with partners and commissioners meeting regularly and being encouraged to surface system wide challenges and jointly unpick constraints such as access to services (e.g. parts of health or welfare) and build pathways where needed. The digital capture of everyone in health and ASC to refer was a mammoth task, as well as getting the DPIA sign off from the local medical council – the time to do this should not be underestimated.

Additional Comments

A real case the partnership has supported (anonymised) – Rani is 27 years old, has a 1yr old, and is pregnant, moved to Oldham from India when she married her husband 3 years ago, and has recently lost her husband. Rani visited the GP several times about low mood and physical aches and pains. Sensing this was more than just medical issues at play here, the GP in Oldham West referred Rani the Social Prescribing partnership. Rani is now accessing community bereavement support, knit and natter.