ADD2492 Social Prescribing and Mental Health

1.1 The Mayor’s Health Inequalities Strategy (HIS) sets out priorities to improve Londoner’s health and well-being. Mental health is a priority area and social prescribing is an important approach to tackle inequalities. The key ambition for social prescribing is to help more Londoners in vulnerable or deprived communities to improve their health and wellbeing.



1.2 Mental health and wellbeing is a priority of London’s response to the COVID-19 pandemic, and improving wellbeing is one of the London Recovery Board’s Missions. Social Prescribing has provided vital support to Londoners during the pandemic and will continue to be an important means of taking action on the social determinants of individuals’ health as we move into recovery.

Social Prescribing

1.3 Social prescribing is a core element of the NHS Long Term Plan to do more to prevent ill-health and keep people in good health. The latter sets out ambitious plans to increase social prescribing activity and the number of Link Workers deployed during 2020/21 and 2021/22. Link Worker numbers across the London health system increased over the last 12 months to around 250 and is set to increase by a further 50 by early 2021. It is vital that as a universal service social prescribing is targeted effectively at those cohorts and sectors of the population who most need additional health support and have poorer health. This is set out in the Mayor’s Health Inequalities Strategy.

1.4 Social prescribing by Link Workers will generate increased demand for help and support. This is a significant opportunity to help deliver the benefits of social prescribing to all Londoners, ensuring that activity is focused on tackling inequalities and supporting those who have been most impacted by COVID-19. The increase in demand for social prescribing and the impact of COVID-19 also creates significant challenges for the provision of appropriate support. Additional activity will need to be developed, mostly by Voluntary Community and Social Enterprise (VCSE) organisations.

1.5 Next Steps for Social Prescribing in London, published in October 2019, sets out the Mayor’s partnership approach for growing social prescribing and the five principles outlined are being taken forward in the GLA, NHS and other partners’ work. These are:

• Available to all: ensuring provision meets individual needs, reflects the assets and priorities of local communities, and ensures that all residents, including the most vulnerable, can access and benefit from it.

• Easy access: through education, self-referral and referral by a wide range of partners, such as health professionals, education and library services, social care services, care homes, housing associations and many others.

• A supported workforce: ensuring that link-workers and volunteers receive the training and support that they need.

• A vibrant and supported Voluntary Community and Social Enterprise (VCSE) sector: that is regarded as an equal partner in the design and delivery of services, is adequately funded and has the necessary tools to be central to the growth of social prescribing in London.

• A localised system: that allows innovation and co-production between commissioners, the VCSE sector and service users, to develop local approaches built for that community, reflecting its assets and its needs. As outlined in “Next Steps”, the priority work areas were developing the workforce, enhancing digital opportunities, supporting the VCSE sector, and providing leadership for London in terms of advocacy and funding – with the latter two led by the GLA.

1.6 The development of Next Steps was informed by the Social Prescribing Advisory Group (SPAG), which was set up in 2018 to support the work programme. In spring/summer 2020 at the start of the pandemic, the Mayor convened three extraordinary meetings of the SPAG, chaired by his Health Advisor Dr Tom Coffey. These were a mechanism to bring together stakeholders in different sectors and geographies to share perspectives and experience, discuss challenges and opportunities and share learning and examples of practice.

1.7 The pandemic has only emphasised the importance of working to further support and develop social prescribing in London; it has been vital to the response for vulnerable Londoners. Informed by engagement with the sector through the SPAG and our partnership working group, GLA priority strands of work for 2020/21 in support of the priorities set out in Next Steps are as follows:

• Supporting the VCSE to deliver social prescribing as an equal partner.

• Mainstreaming activity to support social prescribing commissioned provision by the GLA is available to all.

• Supporting the alignment of social prescribing partnership working (VCSE, NHS and Local Authority partners) to enable a localised system.

• Championing and leadership role to promote the value of social prescribing.

1.8 The second priority, ‘Mainstreaming activity to support social prescribing...’ builds on the commitment made in Next Steps (as part of the ‘Championing’ priority) to include health and wellbeing as a core part of Mayor of London grant programmes. This is shown through supporting Londoners to engage in sports and physical activity, culture and the arts, volunteering, improving green spaces and encouraging social integration, and through the Mayors more recent powers and funding for adult education.

1.9 Social welfare legal advice (SWLA) is also an area of focus in Next Steps. A piece of work has continued through 2020 to explore how SWLA was being delivered in health settings, and how this could be built upon. This report complimented the mapping availability of SWLA in London by ASA, commissioned by Fairness and Equality.

1.10 The funding of £10,000 for a report on SWLA in a health setting by the Bromley By Bow Centre was approved by a Delegated Authority Record (DAR) in May 2019. This was joint funded with the Legal Education Foundation.

Mental Health and children

1.11 The health of children and young people, and particularly in terms of mental health are priorities outlined through the HIS. The first and second objectives of the HIS speak to the importance of supporting parent and families, and the role of early years settings in terms of children health and wellbeing, as part of a life-course approach.

1.12 Recognising the importance of Londoners’ mental health and wellbeing not only now, but as core to recovery. One of the London Recovery Missions will focus explicitly on mental health and wellbeing, stating that ‘by 2025 London will have a quarter of a million wellbeing ambassadors supporting Londoners where they live, work and play,’ speaking to all of the priorities of the Action Plan.

1.13 Parents and families of young children are one of the priority groups identified by Thrive LDN and other research into the impact of the pandemic on health and well-being. The Mayor has a number of levers in this space, including the three Early Years Hubs, set up in Barnet, Newham, and Wandsworth and Merton in 2018, which aim to improve access to high-quality early education for London’s less advantaged families.

1.14 The mental health and early years activity proposed will build on existing work developed within the Mayor’s Wandle Early Years Hub and support further dissemination across all three Early Years Hubs. The focus of activity on early years wellbeing pedagogy will help the hubs to support parents and families contributing to the mental health and wellbeing Recovery Mission.

1.15 The Mayor’s Early Years Hubs were funded £525,000 for the period January 2018 - December 2020 and approved by MD2147.

COVID-19

1.16 Throughout the pandemic on-going surveys of the VCSE have consistently identified mental health and concerns about social welfare legal advice (SWLA) as top priorities for Londoners. In December the results (more details on the London Data Store) found:

51 per cent of responding organisations (57) saw an increase in the number of people seeking support in the last two weeks and the issues with the highest proportion reporting higher demand are mental health, isolation, employment, housing and poverty.

Mainstreaming social prescribing

2.1 There are increasing examples of social prescribing activity being commissioned and supported by colleagues across the GLA Group.



2.2 We are keen to learn from the success to date of where social prescribing has been embedded in work and build on the experiences and lessons to enable such activity to continue.

2.3 However, the information about the projects, activity, outputs and impact, lessons learnt and challenges, are not collated to provide an overview which would better support the Mayor’s leadership and champion role. This project will gather together information, illustrated through case studies, demonstrating the success of activity to date, as well as learning from challenges and barriers.

2.4 This will not be a formal evaluation of the activity, requiring beneficiary data etc to be provided. It is a strategic overview and will provide some narrative about the size, scale, focus of activity across the GLA group, planned and intended outcomes and outputs as already available at a project level and process and delivery challenges and success.

2.5 Examples of GLA group social prescribing activity include:

• The Culture and Creative Industries (CCI) Unit has commissioned Social Prescribing Demonstrator Projects being rolled out across Merton and Southwark; research including London Borough of Culture health and wellbeing and community response hubs; and a social prescribing myth busting guide.

• Team London’s small grants programme 2019/2020 funded fifteen small charities and voluntary sector organisations to run volunteering projects that help people who are experiencing loneliness and social isolation. These Londoners are sometimes referred through social prescribing to small charities and voluntary sector organisations.

• Community Sport Teams Open Data project which aims to learn and demonstrate how to support referrals into physical activity through social prescribing.

2.6 Bringing information together from across the GLA group will increase organisational knowledge and learning about the individual projects. It will provide impetus for organisational improvement in commissioning related work. It will harness opportunities to develop work of value to social prescribing link workers and VCSE activity providers. This will include identifying opportunities for social prescribing to support the delivery of the Recovery Missions. The project will engage with Link Workers and the VCSE sector to improve our understanding of the best ways to improve commissioning and collaboration with them and develop materials and processes to support that. The outputs are likely to include case studies, an evidence base, toolkit and resources for social prescribing commissioning of relevance to the GLA group, Link Workers/GPs, VCSE and local authority commissioners illustrating the benefits across different sectors. The project will also feed into a wider pan-London debate about commissioning sufficient activity and meeting demand whilst addressing health inequalities.

2.7 This project will:

• Showcase how different GLA group activities have benefited Londoners health and wellbeing through social prescribing

• Identify how we can build on activity to mainstream social prescribing through more of our work

• Develop materials that helps colleagues across the group develop projects that will be of value to social prescribing

• Improve knowledge in the GLA of social prescribing commissioning and delivery, and through cross-agency collaboration to support the wider system of delivery with link workers to achieve better understanding of the social prescribing landscape to inform the process and by commissioning social prescribing at the GLA

• Identify opportunities to support delivery of Recovery Missions

• £15,000 is being allocated to this project.

Social Welfare Legal Advice (SWLA)

2.8 Improving access to SWLA has been identified as a key challenge for the safety net Recovery Missions. SWLA is identified through surveys of London link workers as one of the top four non-medical issues that patients raise (the other three are mental health, housing and digital exclusion). Although SWLA services are taking place in some GP surgeries and there is evidence of referral mechanisms in place in some boroughs, there is limited co-ordination and integration of SWLA and social prescribing. A GLA/Legal Education Foundation commissioned report on SWLA in health settings by Bromley By Bow Centre sets out a menu of options to enhance SWLA delivery in health settings. With the increasing demand for SWLA as a result of the pandemic and the focus on the safety net Recovery Mission this work will support health partners with other partners to implement the recommendations and establish pilot projects for welfare advice in health settings.

2.9 This project will:

• Commission Bromley By Bow Centre to take forward an implementation programme of activity between January and March 2021. This will launch with a webinar in January to bring together Health, VCSE, local authority and SWLA sectors to stimulate information sharing on existing activity and local activity to enhance access to SWLA.

• Bromley by Bow Centre will provide further follow-up engagement and networking and re-convene boroughs and clinical commissioning groups with SWLA agencies.

• This activity will be aligned to and support the Safety Net Recovery Mission.

• £6,000 is being allocated to this project.

Migrants' rights, entitlements and access to healthcare

2.8 The Mayor’s response to the Public Health England Consultation on Social Prescribing Approaches for Migrants (October 2020) identified a gap in social prescribers and link workers knowledge about NHS rights and entitlements for migrant populations and how barriers to GP registration might impede access to social prescribing models. Any strategy which seeks to tackle health inequalities must ensure equity of access for migrant populations to health provision that is available without charges. Migrants confidence in health provision for take-up of NHS Test & Trace and registration with a GP for access to COVID-19 vaccinations are both important in terms of overall population health. Information materials will be developed based on collaboration with social prescribing link workers and other health and frontline staff and in consultation with the target communities. The GLA will also work closely with the Healthy London Partnership, ADPH and London boroughs to disseminate the materials.

2.9 This project will:

• Procure a specialist provider to produce materials to improve knowledge and information about refugee and migrants right to and access to health care, by social prescribing link workers, health and other frontline staff.

• Dissemination of materials via social prescribing, health and public health networks.

• £7,000 is being allocated to this project.

Early Years and Mental Health

2.10 Concerns about mental health has been identified as a major impact of COVID-19. Thrive LDN have brought together available research and evidence on the impact of COVID-19 on Londoners’ mental health and wellbeing. Five working papers have been published to date, providing information on:

• The known impact of COVID-19 on prevalence of poor mental health, suicide and bereavement.

• Mental health impact of lifting of economic and other support.

• Disproportionately at-risk groups, including children and young people and ethnic minorities.

• Anticipated demand for mental health support.

• The need for transition and recovery planning to apply the principle of proportionate universalism.

• Recommendations around how to address inequalities, support Londoners to strengthen their resilience and options for enhanced support.

2.11 The focus of the commissioned activity will be to support health and well-being for early years staff, children and parents.

2.12 Wandle Early Years Hub, supported by the Mayor of London, will be grant funded to deliver this project. This will include expanding the delivering their existing health and wellbeing training for early years staff and developing new resources for parents. Online content will be developed to support the early years professional training with additional new material to support parents to support their own and children’s wellbeing (this is complementary to the Early Years Hub toolkit being developed). The three Early Years Hubs will collaborate to lead dissemination via their own networks, Healthy Early Years London and London Early Years Network.

2.13 This project will:

• Grant fund the dissemination of early years well-being pedagogy training developed by the Wandle Early Years Hub to the Mayor’s other two early years hubs.

• Undertake further activity across the three early years hubs to increase the knowledge of the importance of mental health and wellbeing support for staff, parents and carers beyond the Early Years Hubs members. This will be achieved through the Hubs’ own sub-regional training programmes.

• Develop new online materials and curate existing materials to support parents.

• £17,000 is being allocated to this project.

3.1 Social prescribing has developed many initiatives which are targeted at the most deprived communities including the elderly, those with long term medical conditions and those with complex medical and social needs. This targeted service delivery will cut across the protected characteristics of age, disability, gender reassignment, pregnancy and maternity, race, gender, religion or belief, sexual orientation. Gathering together information about existing GLA group social prescribing activity will develop understanding as to the beneficiary’s characteristics including protected characteristics and socio-economic groups and the necessary data to understand take-up and impact. Social prescribing has the potential to have an impact on multiple groups with protected characteristics under the Equality Act 2010.

3.2 As part of the project outputs, we will explore with GLA teams and external partners how more Londoners can access social prescribing and how it can be developed in collaborative and participative ways. In doing this we will address the recommendations of the PHE BAME report “Beyond the Data” and particularly recommendations on targeting and culturally competent activity: “Accelerate efforts to target culturally competent health promotion and disease prevention programmes for non-communicable diseases promoting healthy weight, physical activity, smoking cessation, mental wellbeing and effective management of chronic conditions including diabetes, hypertension and asthma.”

3.3 The proposed work will also enable an overview of beneficiaries. Not all of the projects will have required referrals from the health sector, but instead will have drawn referrals through local community routes.

3.4 The Mayor is committed to social prescribing as a mechanism to address health inequalities. This overview of projects to date will help inform how future activity is commissioned to achieve this objective.

3.5 The pan-London research undertaken through the London Rapid Recovery report and the public health analysis of published reports (Vulnerable groups and COVID-19) has identified which protected characteristics, ethnicity groups and areas of London have been most impacted by COVID-19. These has been further informed by stakeholder and community engagement as well as the VCSE survey. This information will inform targeted activity.

a) Key risks and issues

4.1. Although social prescribing is not new, the ambition from NHS and other service commissioners to formalise the approach, whilst also ensuring that services remain local and accessible does raise some challenges. Rapid growth of the sector could result in the current number of (mainly VCSE) referral services not meeting demand as well as the voluntary sector not having the capability or infrastructure to engage fully with social prescribing. These proposals seek to go some way to identify and alleviate some of these issues, particularly in respect of sharing good practice and ways of working across the VCSE.

4.2. Successful delivery of this project will require input from GLA group teams and partners. Teams have been consulted on the development of this proposal and the consultant will need to work closely with all teams to access information and engage with delivery partners.

4.3. Additional funding for the Early Years hubs will be through a grant extension.

4.4. There are no conflicts of interest to note.

b) Links to Mayoral strategies and priorities

4.5. The Mayor has made a commitment to a mental and physical ‘health in all policies’ approach, which means that the GLA will consider health and health inequalities in everything it does.

4.6. As well as being a major ambition within the London Health Inequalities Strategy, the growth of social prescribing also features within the Culture, Environment and Sports strategies and the London Food Plan. Given that the support people can seek through social prescribing varies significantly for each individual (for example housing, benefits, fuel poverty, employability, disability rights advice alongside activities such as projects to reduce loneliness and isolation and access to adult education to name just a few) the majority of teams with the GLA have an interest in social prescribing.

4.7. A GLA wide group has been established to keep a light-touch overview of the policy interest and any associated projects for each team, supporting information sharing and collaborative work between teams.

4.8. The Recovery Missions all have the potential to utilise social prescribing either alongside or as central to the delivery mechanisms. This project will be timely to contribute to the cross-organisational approach to the delivery of the missions.

4.9. The SWLA scoping implementation and information materials on migrants’ access to health will support wider activity to deliver the safety net Recovery Mission.

4.10. The training and dissemination of well-being pedagogy to the early years sector will support the mental health and well-being Recovery Mission.

c) Engagement and Consultation

4.11. Engagement with the social prescribing sector occurred during spring/summer 2020 to understand the priorities and areas where the GLA could add value. Further consultation has also taken place with the London Plus, HLP and the NHS as part of personalised care planning across London to identify areas where joint work is most effective. One area identified for improvement was the linkage of GLA social prescribing commissioning and delivery activity to Link Workers and the VCSE sector activity in boroughs. This area for improvement will be a key focus for this social prescribing and mainstreaming project.

4.12. The development of SWLA in Health report undertook stakeholder engagement including with the Social Prescribing Advisory Group and further engagement is planned as part of the implementation.

4.13. Engagement on the needs of migrants and refugees’ access to healthcare took place through a workshop session convened with London Plus and this formed a key element of the Mayor’s response to the PHE England consultation on social prescribing and migrants. Link workers will be further engaged in the delivery of the project providing feedback and helping to problem solve to help improve future commissioning and engagement activity.

5.1 Approval is being sought for expenditure of up to £45,000 to commission activities relating to the Social Prescribing (£28,000) and Mental Health – Children (£17,000) workstreams within the Health Unit.

5.2 This expenditure of £45,000 will be funded from the Health Team Programme budget for 2020/21.