Recent years have seen increasing interest from high level policymakers in social prescribing as a means of improving public health and wellbeing generally and specifically as a route to work.

Our upcoming report explores whether this changing policy emphasis has influenced social prescribing in practice, leading to changes in social prescribing services’ work ‘offer’ and emphasis placed on work and related outcomes.

Ultimately, the work aims to inform policymakers on the realities of social prescribing as a route to work and whether these ‘high level’ policy aspirations have come closer to being realised.

Social prescribing enables (often primary) healthcare professionals to refer people to a range of non-clinical services, normally provided by the community and voluntary sector. Through its holistic, whole-person approach, addressing and improving a wide range of health and wellbeing outcomes and their determinants, it been recognised for its role in supporting individuals to find and/or retain work. This is significant given how important work is for people’s health and wellbeing.

Our 2016 report, produced as part of the Fit for Work Coalition, explored how widespread employment-focused services were within the social prescribing ‘sector’. It hypothesised two ‘pathways’ to work:

  • direct: where an individual is referred to a work-focused service; and
  • indirect: where, by first addressing basic needs and building on people’s ‘assets’, (e.g. improving confidence and self-esteem, reducing symptoms of anxiety and depression, as well as providing education, training and volunteering experience, social prescribing can break down the barriers to work), this equips people with the skills they need to find – and stay in – employment.

It found that work and related outcomes were not a common feature of social prescribing services. However, a lot has changed since then. High level policymakers, including the Prime Minister and Secretary of State for Health and Social Care, have lauded social prescribing as an innovative means of improving the public’s health. It has also gained attention from NHS England and the Government’s Joint Work and Health Unit as a way of addressing worklessness.

These changes are reflected somewhat in the current literature, with a number of social prescribing service evaluations now (in comparison to 2016) explicitly recognising work and work ‘readiness’ as an outcome. A survey of members of the Social Prescribing Network also revealed widespread recognition of social prescribing serving as a – primarily ‘indirect’ – route to work.

Furthermore, primary and secondary research conducted with four social prescribing services in England revealed that, since 2016, while getting people into work via a ‘direct route’ was not prioritised, there was, arguably, more value attached to work. For example, all services now collected some form of work/employment data.

Overall, the findings suggest that social prescribing services still sit primarily in the health ‘space’ and thus there is a strong focus on health/clinical priorities. In the four services we studied, referrals still came exclusively from the health and social care system.

This research, therefore, suggests that further integrating work and related outcomes into social prescribing schemes still presents a number of challenges. There are ‘cultural’ barriers – due to social prescribing sitting in the health/clinical ‘space’. There are also practical barriers, relating to the lack of experience amongst social prescribing practitioners to support clients on a journey towards work.

Based on our findings, we make five policy recommendations on how to overcome these barriers and maximise social prescribing’s potential as a route to work.

  • Recommendation 1: Improve awareness of ‘work as a health outcome’ among social prescribing stakeholders
    • Greater awareness of the health protecting and improving role work can play amongst funders/commissioners, referrers and Link Workers will naturally increase the emphasis social prescribing services place on work and related outcomes.
  • Recommendation 2: Facilitate partnership working to include employment-focused services
    • Social prescribing is extraordinarily good at building trust and partnerships between local health services and wider services in the VCS. This partnership approach could be extended to include employment bodies/services operating in the local community. Clients who have had/do not need more ‘basic’ needs met could be linked with these services towards the end of their ‘journey’ towards work.
  • Recommendation 3: Diversify/pool social prescribing services’ funding streams beyond the health and social care system
    • Currently, funding for social prescribing schemes comes primarily if not exclusively through the health and social care system, which inevitably influences what targets are set and which outcomes are measured.
  • Recommendation 4: Carefully develop work and related outcomes for social prescribing services
    • The integration of work and related outcomes into social prescribing must be carefully managed. In short, they must account for what is most likely to be an ‘indirect’ route to work.
  • Recommendation 5: Commission new research to develop bespoke tools/methodologies
    • Social prescribing is a powerful means of reintegrating the ‘hardest to reach’ groups into the community, improving their health and wellbeing, and, by first prioritising their basic needs, empowering them to take steps towards employment. There is a distinct lack of evidence demonstrating the value of social prescribing in this regard.

For further information on these recommendations – and how they might be implemented – keep an eye out for the report.

About the author

Dr James Chandler

Policy Adviser at the Work Foundation