The coaching sector finds itself at the forefront of a growing movement that is dedicated to radical social change.
‘Social prescribing’ is a term that is heard increasingly in everyday language, keeping pace with the growing number of social prescribing intervention programmes that are sprouting up in every county and major city across the country.
Advocates believe social prescribing could be the silver bullet that can alleviate a great many complicated and deep-rooted issues that are adversely affecting both the health and well-being of the nation, and our nation’s pressured healthcare system.
So, what is social prescription, what role do coaches play in the process and how can the sector best position itself as the movement continues to gather momentum?
First and foremost, don’t be misled by the word ‘prescription’. Social prescribing has nothing to do with pieces of paper signed by a GP that are exchanged at a pharmacy counter for medicine or pills.
Also known as community referral, it is the umbrella term for non-medical interventions that have prevention at their core, not cure.
Why everyone’s a winner
The Social Prescribing Network defines the process as ‘a means of enabling GPs and other frontline healthcare professionals to refer patients to link workers’. Trained link workers then have a lengthy face-to-face conversation with the patient to determine which social activity might impact most effectively on their specific health needs. The idea is to empower patients, through one-to-one support and signposting, to design their own personalised health solutions.
According to the Low Commission published in 2015, it is estimated that around 20% of patients consult their GP for what is primarily a social issue – an area doctors are not specialists in and so are not best suited to offering advice on.
The option to refer patients with emotional or social needs to trained link workers instead enables GPs to spend longer treating those patients with medical conditions, reducing the pressure on our overworked family doctors.
Furthermore, receiving tailored support and connecting patients to services and activities provided by the community sector that positively impact on their health and well-being reduces the chances of them developing further health conditions in the future.
This triggers a domino effect that has positive economic ramifications on the wider National Health Service as fewer people seek treatment, leading to fewer hospital admissions.
To say ‘everyone’s a winner’ may seem a little trite but if the roll-out of social prescribing programmes continues apace then it is a fair boast.
Proactive about getting active
Ways to Wellness is a social prescribing operation based in Newcastle that is helping clients live healthier lives.
It is an umbrella organisation that coordinates the activities of two provider organisations: Mental Health Concern and First Contact Clinical. Together they employ 25 full-time link workers who manage a case load of approximately 90 clients each, aged 40 to 74, with long-term health conditions (which include asthma, type 1 and type 2 diabetes, heart disease and osteoporosis) as well as people who need help with managing depression, anxiety and social isolation.
They are referred initially to Ways to Wellness by a number of participating GP practices located in different areas of Newcastle West.
While there are a multitude of social interventions that link workers can signpost to – from bridge clubs to bee-keeping, book clubs to bingo – coach-led sport or physical activity sessions that combine the opportunity to make social connections are a popular and effective means of driving sustained behaviour change.
“The main external provider we signpost to is Active Newcastle, an initiative run by Newcastle Council in tandem with a range of local partner agencies,’ explains Ways to Wellness Service Manager Mark Adley.
People we work with will go to a gym in a small group and they will have two free sessions a week for ten weeks. They will be shown how to use gym equipment, advised on different circuits and be given their own targets around their physical health, with support from staff. And then after that they will be offered a discounted gym pass.”
Ways to Wellness works with a host of other key partner agencies in the city, including HealthWORKS. They also provide exercise on referral but in a smaller, more intimate setting than Active Newcastle, which can be helpful for people with more complex mental health needs or people who may be intimidated by going to a gym.
“Then there is the Healthy Lungs course, which BOC Clinical Services run, which is phenomenal for people with asthma and with COPD [Chronic Obstructive Pulmonary Disease]," adds Mark.
“And because physical and mental health are so closely linked, all [of] those signposting agencies also offer an element of social support, which is central to people’s well-being.”
Identifying the causes behind the causes
Social prescribing addresses the fact that social issues have an equally significant impact on health and well-being as physical and psychological factors.
And while developing active habits is the number one referral intervention, it may not suit every client’s need.
This is why we undertake a comprehensive initial assessment of a person’s life,” Mark explains of the initial process. “The conversation allows people to open up about all areas in their life so we can get a detailed picture of the causes behind the causes.
“Take someone who smokes, for example. The doctors will have advised them about the importance of cessation, but underlying that they may be going through serious relationship problems, be dealing with mental health issues etc. So, before you can do any coaching or supporting the initial behaviour that seems to be problematic, you really need to dig a bit deeper.”
While the community workers or coaches are the ones at the coal-face providing social opportunities and eliciting behaviour change, so the link workers have an equally crucial role in the background ensuring their clients are connected with the people who are best equipped to help them.
Broader definition of coaching
Link workers go by a variety of names – health advisor, health trainer, community navigator, well-being coordinator, care navigator – and in many ways fulfil the role of coaches themselves, as they too are responsible for converting people’s motivations into action. They do this through adopting a person-centred approach to achieving positive behaviour change and by building strong relationships with their clients.
Mark – who is hesitant at my use of the word ‘coach’ – is keen to point out that link workers do not push clients into changing their behaviour, rather they work to “evoke and elicit change”.
“As a practitioner, I always try and get the people who I work with to argue for change rather than me doing it.
Some people are what we call activated people, and signposting them to exercise on referral is just what they need and all that they need. And then there are people at other end of the spectrum, for whom we have to adapt our style. Our role is to try and empower and support people to really take ownership of their physical and mental health.
“If you are looking, for example, at someone in extreme poverty, who has complex health conditions or is living with mental health issues, then attending a gym or getting out and about might be way down their list. To push them into it would not work. That level of activation comes later.
“So, while we try and enable behaviour change and support that, it is counter-productive to push people if they are not going to attend and who will then feel that they have failed. Fortunately, because we have the luxury of working with people over time, a physical health solution is hopefully where we end up.”
I explain to Mark that, while those working in the social prescribing sector may not look on this initial fundamental groundwork as coaching, UK Coaching would beg to differ. These type of nudge tactics, that draw out the desired response rather than enforce it, and that use a person-centred approach to ascertain what people’s individual needs are in order to negotiate a shared plan of support, is a crucial element of coaching. (You can find out more about UK Coaching’s Connect, Understand = Thrive principle here).
“In terms of the use of the word ‘coaching’, we are in new territory here with social prescribing and language,’ Mark admits.
One of the aims of the Coaching Week campaign is to promote the broader definition of coaching to help bring about a convergence of language and labels.
Relationships and evolving partnerships
I ask Mark how Ways to Wellness collates reliable and up-to-date information about the hyper-local care and support options available when it comes to physical activity referrals.
Are there online directories? Have they compiled a database of local services?
Newcastle has a central database called Information Now, which is very helpful,” says Mark. “But building relationships is essential, as link workers provide a bridge not just between people and community services but also GP practices and community services.”
He adds: “We initially did what is called asset mapping and spent a lot of time pounding the pavements, mapping out local services. But of course, it’s not that simple.
“You then have to develop relationships, because these community assets are obviously central to social prescribing. They come to our team meetings and we go and meet up with them; our link workers will also go and attend courses they put on. It’s a live and ongoing process and is never static. We are always keeping an eye out for new services cropping up, and the local landscape is always evolving.”
The numbers add up
In January, NHS England announced plans to recruit 1,000 social prescribing link workers which, by 2023-24, it hopes will manage around 900,000 patient appointments a year.
The Government, meanwhile, is committed to making social prescribing available in every local area by 2023, vastly expanding the number of patients who come into contact with a suitable intervention programme.
As a key part of the chain, the coaching sector has an important part to play in the social prescribing movement.
Coaching Week 2019 provides compelling evidence of how coaching can play a pivotal role in combating issues which are placing a huge strain on society – inactivity, the loneliness epidemic, an ageing population and the rise in mental health problems and crime – by instilling confidence and self-efficacy, boosting competence and helping to build connections with likeminded people.
Social prescribing is part of the solution to these pressing issues affecting society, which is why UK Coaching is keen to send out this strong message:
It is vital that the coaching sector engages with social prescribing programmes and just as vital that we support and invest in our nation’s coaches.