Abstract
To evaluate the impact of 'holistic' link-workers on service users' well-being, activation and frailty, and their use of health and social care services and the associated costs. UK policy is encouraging social prescribing (SP) as a means to improve well-being, self-care and reduce demand on the NHS and social services. However, the evidence to support this policy is generally weak and poorly conceptualised, particularly in relation to frail, older people and patient activation. Torbay and South Devon NHS Foundation Trust, an integrated care organisation, commissioned a Well-being Co-ordinator service to support older adults (≥50 years) with complex health needs (≥2 long-term conditions), as part of its service redesign. A before-and-after study measuring health and social well-being, activation and frailty at 12 weeks and primary, community and secondary care service use and cost at 12 months prior and after intervention. Most of the 86 participants achieved their goals (85%). On average health and well-being, patient activation and frailty showed a statistically significant improvement in mean score. Mean activity increased for all services (some changes were statistically significant). Forty-four per cent of participants saw a decrease in service use or no change. Thirteen high-cost users (>£5000 change in costs) accounted for 59% of the overall cost increase. This was largely due to significant, rapid escalation in morbidity and frailty. Co-ordinators played a valuable key-worker role, improving the continuity of care, reducing isolation and supporting carers. No entry-level participant characteristic was associated with change in well-being or service use. Larger, better conceptualised, controlled studies are needed to strengthen claims of causality and develop national policy in this area.
Highlights
In the UK, an ageing population combined with a growing number of people living with longterm medical conditions is increasing demand and cost pressures on the acute, primary and social care services (Wanless et al, 2006; Licchetta and Stelmach, 2016)
One innovation that has been consistently advocated for is social prescribing (SP) (Department of Health, 2006; NHS England, 2016a). This is reflected in the appointment of a national general practitioner (GP) clinical champion (Matthews-King, 2016)
We explored the association between age bands (85), sex, PAM Level (1–4) and RCFS score (1–9) on entry to the programme and meaningful change in WEMWBS score (≥5) and Downloaded from https://www.cambridge.org/core
Summary
In the UK, an ageing population combined with a growing number of people living with longterm medical conditions is increasing demand and cost pressures on the acute, primary and social care services (Wanless et al, 2006; Licchetta and Stelmach, 2016). A key demand has been for services to become more integrated to better serve the complex needs of the older, frail population and to be more focused on encouraging supported self-management, as a means to reduce demand on primary and secondary care services, making them more sustainable (Dyson, 2014; NHS England, 2014, 2016a, 2016b). One innovation that has been consistently advocated for is social prescribing (SP) (Department of Health, 2006; NHS England, 2016a). This is reflected in the appointment of a national general practitioner (GP) clinical champion (Matthews-King, 2016). SP is a way of connecting patients to practical, community-based support, including access to advice on employment, housing and debt
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