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London Plus Social Prescribing network talks inclusivity with small VCSE organisations

“Social Prescribing started many years ago to address the issue of loneliness, but now the need is much, much wider than it was before” – Dr Tom Coffey, OBE Senior Advisor to the Mayor of London

What challenges do small VCSE organisations face in delivering inclusive practice in Social Prescribing?

In collaboration with colleagues at the Greater London Authority (GLA), we have now launched our London Plus Social Prescribing Network. The aim of the network is to support and promote the valuable work that the voluntary sector does to deliver social prescribing services across the capital. London Plus does this by sharing information between members and enabling them to work together to tackle the challenges they are facing. By coming together we hope to strengthen the voice of the VCSE in this area. This is the first in a series of blogs exploring inclusive practice in the sector in more detail.

In July London Plus, the HEAR Network and Race on the Agenda (ROTA) hosted an event for small VCSE organisations. The aim of the event was to discuss the current challenges faced to deliver truly inclusive social prescribing. The event considered two dimensions of inclusion. Firstly, ensuring people with protected characteristics, particularly Londoners from ethnic minority backgrounds, are included in the benefits of social prescribing. Secondly, ensuring that small grassroots organisations with specialist knowledge of their communities can engage in the structures and mechanisms of social prescribing.

We know that small organisations have responded magnificently to the incredible challenges of recent months supporting people through the pandemic. Their specialist and localised knowledge make them best placed to work with marginalised and excluded communities most affected by COVID-19.

We wanted to bring these organisations together to share some of the challenges to inclusive social prescribing, including around the impact of the pandemic, and of many services moving online. What do smaller organisations need to continue to support people in this new digital world? How has the pandemic affected their ability to respond? And how do existing inequalities affect social prescribing’s ability to be more inclusive in its practice generally?

Survey findings

We undertook a short survey to find out some of the answers to these questions (Figure 1 and 2).

Unsurprisingly, smaller grassroots organisations cited funding as the main challenge encountered in social prescribing provision; followed closely by issues around supply and demand; and getting referrals through existing pathways. Many organisations were already working close to capacity on limited resources. However, despite an increase in referrals, additional funding was not forthcoming, hampering their capacity to respond. Some organisations observed that this had been an issue before COVID-19, but all agreed that the lockdown period had exacerbated this issue.

It was particularly true for organisations who didn’t have any extra funding in the budget for new digital provisions. Some examples of this were:

  • All staff having to share the one computer in the office;
  • Not having a computer at home that could be used instead;
  • Needing to buy extra licenses, so that access to software could continue from home;
  • No access to a work phone to respond to changing work patterns and having to give out personal numbers.

Please click on the images below to enlarge. 

Bar chart showing the main challenges that existing social prescribing practices, delivery and funding models present for small frontline organisations

Figure 1 – What are the main challenges that existing social prescribing practices, delivery and funding models present for small frontline organisations? (Top 10)

In some cases, this lack of digital provision in itself acted as a barrier to referral, because staff were unable to access online referral channels and databases on behalf of their organisation.

There was also concern that many of those communities that would benefit from accessing social prescribing activities were themselves more likely to be digitally excluded. This is worrying given that people from minority groups are more likely to be affected by the pandemic than other populations, further hindering small organisations specialist ability to reach these groups.

Reflections from participants at the 'changing the prescriptions' event

Figure 2 – a few reflections from participants

So, what can be done?

Dr Tom Coffey OBE (General Practitioner and Senior Advisor to the Mayor of London) confirmed that the GLA are in the process of making grants available to support social prescribing, particularly around the issue of digital exclusion within the sector. This is a great start and should help with including some of those groups identified above. However, it is vital that the VCSE sector is supported to build more strategic partnerships within health and social care. This would help ensure that money flows to where it is needed the most, supporting those who are most likely to be excluded. Through this network, London Plus will be working closely with the GLA and the Healthy London Partnership to see how we can help facilitate this more.

The Whole Person Approach

When we think about inclusivity in terms of social prescribing, we need to be paying attention to the whole person and not just what we think we can see.

“The whole person perspective is a great fit with the social prescribing perspective, it describes its creative opportunity” – Survey participant

It’s vital that social prescribing opportunities and referrals take into account every aspect of a person’s identity, to meet their needs most effectively and appropriately. Faith, age, sexuality, gender and gender identity, ethnic background and disability, as well as key life experiences such as homelessness, all act together in determining how any individual experiences life, and therefore their needs when it comes to social prescribing. We will be expanding upon this intersectional approach in a later blog in this series.

The Inclusivity Question

The Mayor has stated that he is keen to support the health of the voluntary sector and encourage its diversity, ensuring everyone who needs access to social prescribing is included, with services as inclusive as possible.

However, for many participants, existing social inequalities played a very significant role in preventing inclusive social prescribing practice. They were also seen to contribute to wider health inequalities more generally (Figure 3). Participants observed that:

  1. Current social prescribing models are prone to producing “a cycle of inaccessibility”.

    Many existing services and models are not co-produced with the wider community, leading some groups to be excluded from the development of policy and practice.

  2. Successful referrals within London are influenced by a “postcode lottery”.

    Some boroughs have a more integrated social prescribing offer than others, providing residents with more accessible activities than is the case in other, less integrated boroughs.

  3. Key decision makers are more likely to be white than BAME, leading to unconscious bias in practice.

    The lack of BAME people in managerial positions within these organisations often results in the challenges they face being misunderstood or not recognised (unconscious bias).

Participants comments regarding current inequalities within social prescribing

Figure 3 – participants comments regarding current inequalities within social prescribing

It is clear that unless we can address some of these systemic problems identified by these small organisations, truly inclusive practice is unlikely to reach those communities who need it most and could benefit greatly from it.

For enquiries and further information please contact London Plus, HEAR and Rota.