Social prescribing: can it help disabled children?

Abstract

Day-to-day clinical practice in child neurology provides frequent reminders that despite our best efforts, medical management represents only a small fraction of the determinants of health. Genetic factors, social circumstances, environmental conditions, and behavioural choices together have a greater effect on health outcomes than medical management.1 Inequalities exist in all of the above: with a few notable exceptions to date, genetic factors can not be addressed, but the others can, should be, but often are not. It is worth taking a moment to reflect on non-medical influences on health facing children with complex chronic conditions and their families. Families spend many hours providing and coordinating care, often experiencing new financial pressures as they cut back or cease their paid working hours to accommodate this role.2 For some, this will be the tipping point into poverty, with further adverse effects on health. Furthermore, families with a child with a chronic complex condition often have mulitple unmet non-medical needs and express difficulty accessing community services.2 The COVID-19 pandemic has heightened these pre-existing problems through increasing social isolation, adversely affecting mental health and disrupting service provision,3, 4 as documented by the Disabled Childrens Partnership in their 2020 report ‘Left in Lockdown’ (https://disabledchildrenspartnership.org.uk/left-in-lockdown/). I strongly believe that all practitioners have a responsibility towards addressing the broader determinants of health of their patients – but we do not have the resources to do this all on our own. By its very definition, unmet need is not being adequately addressed by existing services. In primary care, the proposed solution is ‘social prescribing’.5 This term is perhaps confusing as it suggests a formulaic approach in which a specific service is prescribed to address a specific condition. However, the approach is necessarily more flexible than its pharmacological namesake: social prescribing relies on matching locally available community assets to the needs and interests of the client. In practice, this matching process is done by a link worker, following voluntary referral to the service. The link worker takes time to discuss the clients’ priorities and supports them in engaging with appropriate local services. Social prescribing is a key component of universal personalized care, supported through NHS England as part of the NHS Long Term Plan. At present it is mostly accessed by adults. There is emerging evidence of improved well-being, as discussed in a recent report by the Kings Fund. Schemes for young people are emerging, but to date there is only one reported evaluation, accessible through the University of East London repository (https://repository.uel.ac.uk/item/88x15). Findings are preliminary but encouraging.