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Challenges and changes for social prescribing in Camden

During the Covid-19 pandemic, the social prescribing service in Camden has evolved from being a linear pathway to a responsive network of support, collaborating between various communities, in providing personalised care to the residents. Donna Turnbull, the Community Development Manager at Voluntary Action Camden (VAC), explains the gradual evolvement of the service since March 2020 in this informative blog. VAC hosts Community Links for the Care Navigation and Social Prescribing Service

 

The Care Navigation and Social Prescribing Service in Camden is a collaboration between 3 teams –

  • Age UK Camden employ Care Navigators and some of the Primary Care Network (PCN) social prescribers. They support residents with long term health conditions.
  • Wish+ at Camden Council provide access to multiple services, for example, council services related to housing, care, and welfare.
  • Voluntary Action Camden host Community Links, the first point of access: for triage into the right part of the service and connecting residents to community-based activities and opportunities.

 

Service adapting due to the Covid-19 pandemic

In March 2020, the service had to change quickly in response to the pandemic and the increasing numbers of residents self-isolating. As the first point of access, Community Links, already partly operating via a freephone and email, was not too difficult for staff to coordinate remotely. So, they were able to respond early to the influx of calls from worried residents. Care Navigators, who usually provide home-based support or work from GP practices, also started to work via phone and the internet. The switch challenging for vulnerable residents used to meeting in person, but overall, with some additional resources, the service adapted well - well enough to cope with a threefold increase in referrals in the first few months. Most referrals at that point were for the delivery of food and medicines, organising care for shielding residents and discharged hospital patients, and for information about what was happening, and where to get help. Working closely with voluntary sector colleagues, social care and housing officers, and local GPs, the service settled into managing referrals into newly adapted community-based support.

 

The social prescribing service itself continued to evolve and respond. For example, the Care Navigation team organised care for patients discharged from local hospitals, and Community Links volunteers became coronavirus test buddies, providing phone and online support for those nervous about home testing.

 

There have been many changes in the types of referral coming through Community Links, and the service generally. Alongside requests for food and medicines, staff and volunteers have supported hundreds of residents to find the tools they need to manage their situation themselves – packages of phone numbers, web addresses, information about support available, phone numbers for local grocery shops, up to date trusted information on Covid-19, and key emergency contacts. Behind the scenes, the Community Links volunteers, local community organisations and mutual aid volunteers helped to provide the latest details from neighbourhoods.

 

By June there was an inevitable rise in referrals related to mental health. Compared with the previous year, despite lower numbers for these referrals, the nature of the support needed had changed. Instead of receiving referrals for preventative action, for example, to help manage or prevent depression, referrals came from and for people in crisis - results of bereavement, domestic violence, prolonged isolation, job losses and debt, or not contacting health services. 

 

Today, nearly a year after the emergency began, the impacts of social isolation are at the core of most referrals into Community Links. Within the service the PCN based social prescribers are taking more cases related to mental health, working closely with Care Navigators and the Community Links volunteers. 

 

During last summer, as restrictions were eased Community Links retrained volunteers to work remotely and set up a ‘chat and link’ initiative. The volunteers now work remotely supporting residents who are reluctant to engage with anything else but will accept a wellbeing call from the service. The volunteers are assigned to someone they call weekly and eventually introduce them to local activities or opportunities to connect with a wider community. The process mirrors what the volunteers used to do in GP waiting rooms and is also helping the volunteers themselves cope with isolation. Some of the calls have exposed more complex problems that have then been passed on to Care Navigators who can then involve clinicians and social workers. The volunteers are also taking some of the pressure off the PCN based social prescribers who have found themselves with enormous caseloads. 

 

New initiatives

The interactions between the teams within the Care Navigation and Social Prescribing Service have increased as referrals have become more complicated. Some new initiatives the service has launched have been made possible by the pandemic. For example, the high number of volunteers in the borough has enabled collaboration with the 'Time to Spare' volunteer scheme to provide patient escorts for medical appointments. There has been a need for this for some time and can make a difference in whether someone attends their health appointment or not. Particularly now fear of going out has become part of the Covid-19 legacy.

 

Another change has been the source of referrals into the Care Navigation and Social Prescribing Service. Before Covid-19, the main referrers were GPs, a few other NHS services and trusts, social workers, and some people self-referring. Since March 2020 self-referrals have formed the single largest source. Up to 70% of referrals have come from black and ethnic minority residents. Local community organisations have also started referring residents to the service, especially those with higher needs than they can support, or people who may need support from a different service or neighbourhood. 

 

Community groups delivering food have been particularly good at locating people in distress, and those who may have been hidden from mainstream health services and referring them. Likewise, housing officers have been thorough in finding and referring isolated residents, often with high or complex needs. And there have been referrals from different NHS services; particularly mental health services, for residents who might benefit from social activity and community support. 

 

The challenges and changes of the past 11 months have enabled some new thinking and an opportunity to add value to the Care Navigation and Social Prescribing model. For example, supporting hospital discharge at the complex end of the service, or diversifying volunteer roles to find different ways to connect isolated residents with real and virtual neighbourhoods. It appears that far more people finally understand how social prescribing helps to address the wider determinants of a person’s health.

 

A network of collaboration

The pandemic has meant we have all had to move quickly, trust our collaborators, and take some risks. The quick start, the pace of adaptation, and the different types of cross-sector working being tried and tested is building knowledge, connections and hopefully resilience in Camden’s communities. Social prescribing is usually seen as part of a linear pathway of health improvement. In reality, the pathway has never been that straightforward. Since Covid-19, social prescribing has certainly felt more part of a responsive web or network of support. A network built on collaboration and communication across civil society, voluntary and community sector services, the NHS, council, and public health. Once connected to the network, residents can move in whichever direction they need, to address their health needs on their own terms. 

 

For referrals to Care Navigation and Social Prescribing, call freephone 0800 193 6067 or email  nclccg.socialprescribingreferral@nhs.net 

For enquiries or to send information about services, please use  communitylinks@vac.org.uk