Social Prescribing – Empowering District Councils to Transform Public Services

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

Chorley Council and South Ribble Borough Council have demonstrated the huge impact district councils can have when they extend their core functions to support health and social care. Through their innovative approach, they have developed social prescribing functions embedded within early intervention and community support services, enhancing their effectiveness. The councils’ local presence and networks enable them to provide comprehensive and place based support. The service has significantly improved residents’ wellbeing and demonstrated substantial cost savings for the health system. This innovative approach highlights the crucial role of district councils in addressing health and social care challenges. 

Chorley Council and South Ribble Borough Council are two sovereign district authorities in Lancashire with populations of circa 100,000 each. The two Councils work together and share a number of services including leadership but remain separate local authorities. Whilst the Communities functions and the social prescribing services that sit within them are sovereign, the teams work collaboratively to share knowledge and experience. 

The social prescribing services were developed against a backdrop of unsustainable pressures across all public services. The wider context is a system that is fragmented, cumbersome and clunky, and is increasingly based on rationing to manage demand, waiting for issues to escalate and get worse. 

The councils are focused on early intervention and community support and having identified an opportunity to stretch the boundaries of what districts are typically responsible for, developed new social prescribing services. Working with health partners, the councils felt that a proactive social prescribing function, embedded within the wider Communities directorate, was an innovative solution to the increasing pressures on health and social care. 

The service was developed with a mix of funding sources; some posts are funded through core council funding, some are grant funded and some are delivered as a service commissioned by Primary Care Networks. This partnership approach with health colleagues has ensured a seamless experience for service users referred via their GP. 

What are the key achievements? 

The impact on the people of our boroughs is huge. Six detailed case studies have been provided but there are countless examples of people whose lives have been changed for the better. From young people who have regained access to training and employment to older people experiencing extreme loneliness who have been supported to access and then volunteer with community groups, this service touches all parts of the community. These are all individuals whose situation would otherwise worsen, not only negatively impacting theirs and their families lives, but also placing unsustainable pressure on the wider system. 

Using Office of National Statistics preferred personal wellbeing measure, we are able to demonstrate the impact of interventions. The phrasing used in our assessment matches that used by a range of longitudinal surveys, allowing for crosscomparison against UK, Regional and Local norms and trends. The increase in score as a consequence of support from the social prescribing teams shows people’s wellbeing improving to that of general population through our interventions. 

We are also able to demonstrate significant system savings. Based on the information we have from service users about how many times they were using GP services and/or attending A&E, plus their opening and closing PAM scores (The Patient Activation Measure (PAM) assesses the knowledge, skills and confidence of patients to manage their health, and has been consistently used as an outcome measure of health interventions. – National Institute of Health) we can see that each intervention by social prescribing saves approximately £3,500 per person to the health service alone. From April to November 2024 that is a saving of £4,669,000 in Chorley and South Ribble. 

Each FTE Link Worker costs approximately £50k per annum (salary, on-costs, equipment, management, training) and so the brilliance of their work is not only impactful but an extremely good use of limited public funds. There is more we can do together with the upper tier authority to understand the impact on Adult Social Care and opportunities to improve outcomes even further. 

As a function, this service demonstrates that there are innovative solutions to the complex problems experienced across health and social care and that district councils play a key and vital part. 

Case study 

Steven was very depressed and anxious when he came into the service through a referral from Jigsaw housing. He never left the house, or opened his curtains. He was living in a large 3 bed property, with an enormous garden that he had struggled to maintain since his mother died. He had never lived anywhere else. Steven suffers with hoarding disorder; to support him we would set small goals. He was given the options and information about the choices he had. Jigsaw and I discussed housing options and the potential to move and Steve initially found this very tricky to comprehend as he has never lived anywhere else. We didn’t want to overwhelm him, so we slowly started highlighting the positives, location, finances and manageability. He eventually started recognising the positives of this. During the process we recognised he is a talented singer and has fantastic skills with computers. 

– Support from Social Prescribing 

– Food Club Provision 

– PIP 

– Organised the kitchen, and he put music on and had a good sing song, this was encouraged and he was referred to music group 

– Hoarding support 

– Bowling for well being 

– Art and Joy Music group, he is now one of organiser of this group he has utilised his skills and manages the computer and the group dynamics and is giving back to the community 

– He has moved property into a one bed flat. 

Steven says ‘Social Prescribing has helped me make positive changes to my living situation and reduce my stress levels. I have more confidence in my ability to deal with problems that affect my health and hopefully I will continue to improve in the future. Social Prescribing has been a big help to me. I needed a lot of help before and now I don’t need as much as I am in a better situation. I liked that there was no pressure; rather than saying that you have to do this or you have to do that. 

I do feel that the change in the living situation has helped. I do not have to worry about the garden and most of the time I can walk to town, in Coppull I struggled due to buses and money. It has helped that I have a places I can go that I know everyone and do something I enjoy. I love music and love singing. 

As well as the activities he attends, Steve now opens his curtains every day, he meets up weekly with friends he has made for coffee and meals. 

We are going to support Steve to set up a computer programming session within Chorley and once he is settled in his new property we are going to look at doing this. 

How Innovative is your initiative? 

The social prescribing model is not new and whilst many GP surgeries employ their own independent Link Workers, they are unable to easily access this wider network of support and in practice often have limited understanding of the wealth of community and council support available and are consequentially very isolated, doing little more than signposting patients. 

That this service is delivered at a district level is key to its success. By creating a team, co-located with wider council functions including community development, active health, homelessness prevention, and employability, there is a collaborative approach to supporting service users. But it is more than merely co-location that ensures its success. As councils, we are local and often our residents first port of call when they are in need of support. We have networks and partnerships already in place and can call on the strengths of individuals and communities in a way others cannot. We also provide core services that address the wider determinants of health and are focused on prevention and early intervention. Unencumbered by public health or social care, the boroughs have the space to focus on early intervention and prevention, rather than needing to prioritise resources to support people in crisis. 

An additional benefit at a district level is that we have a virtuous circle of individuals receiving support in the community from groups the council has supported and funded, which often leads to the individuals volunteering at these same groups and allowing the groups to offer even better community support. 

What are the key learning points? 

There are real challenges and opportunities available in working with health partners to release funding, and Chorley have benefitted the most from this approach with the service delivered on behalf of local Primary Care Networks. However, working directly with PCNs is not necessarily straightforward and despite significant work being undertaken in South Ribble, it has not yet been possible to replicate the Chorley model. 

Longer term funding of both of the services remains uncertain, reliant upon external funding via health or central government (UKSPF). There is the opportunity to work more closely with social care to connect the dots and demonstrate the whole system benefits, to release funding for social prescribers. 

The value of a team model of social prescribers is significant, enabling shared development and support and a resilient function. 

The main learning point is the value of the service being fully embedded within a communities team with the breadth of support available.