1. Rotherham’s Social Prescribing Services Sarah Whittle – Assistant Chief Officer Wendy Allott – Deputy Chief Finance Officer Rotherham CCG HFMA 18 th November 2015 1

2. Social Prescribing Service: Connects people with long term conditions, referred through case management teams, to sources of support in their community 5 VCS Advisors, employed by VAR, linked to 35 GP practices, work with referred people to find a service or activity that meets their needs 26 VCS organisations receive funding to provide a menu of 33 different services and activities Provides a gateway to a wider pool of VCS services that are not directly funded through social prescribing, predominantly provided by local community centres and groups Extended to a pilot project working with RDASH mental health teams. Pilot started 1st April 2015

3. Huge efficiency challenge - £70m over 4 years Increasing numbers with long term conditions Above average unplanned hospital admissions Recognition that patients need support with non-medical issues - creates a wider range of options for primary care and patient Shift of focus to prevention and early intervention - increases independence, resilience of individuals and communities Supports integration and personalisation Doing things differently – ‘more of the same’ is not an option Why are we doing it? Strengthening individuals, strengthening communities

4. Outcomes for patients and carers Quantitative and qualitative evidence points to a range of improvements for patients and carers: improved mental health greater independence reduced isolation and loneliness increased physical activity welfare benefits Social Prescribing represents an important first step to engaging with community based services and wider statutory provision Without Social Prescribing many patients and carers would be unaware of or unable to access these services 4

5. 5865 referrals out to VCS services (4571 to commissioned services 1294 to non commissioned services) 3627 referrals in to SPS 1487 referrals out to non-VCS 2058 signposts 35 GP practices 5

6. Evaluation by CRESR, Sheffield Hallam 939 clients included in evaluation. Non-elective Inpatient Admissions: Finished Consultant Episodes (FCEs): 7 per cent reduction Inpatient Spells: 11 per cent reduction Bed Days: no statistically significant change A&E Attendance: All patients: 17 per cent reduction This data is for all patients and doesn't tell the whole story: more detailed analysis shows marked differences between different types of patients, in particular: By age By level of engagement with SPS 6

7. When patients over the age of 80 are excluded from the analysis - reductions are greater. (513 patients remaining) Non-elective Inpatient Admissions: Finished Consultant Episodes (FCEs): 19 per cent reduction Inpatient Spells: 20 per cent reduction Bed Days: no statistically significant change A&E Attendance: All patients: 23 per cent reduction Highlights importance of ensuring SPS is appropriate for patients who are referred Impact of SPS on older (80+) patients needs to be understood through other measures 7

8. When patients continue to access VCS services after initial service has ended much larger reductions are now seen to be evident Non-elective Inpatient Admissions: Finished Consultant Episodes (FCEs): 53 per cent reduction Inpatient Spells: 51 per cent reduction Bed Days: 43 per cent reduction A&E Attendance: All patients: 35 per cent reduction Highlights the importance of sustained engagement with VCS services 8

9. Cost/Benefits 9 The service costs £1,171 per patient substantively engaged Reductions in in-patient and A&E lead to savings of:

10. 10 Wellbeing Improvements 83% of patients made progress in at least one outcome area

11. 11 It is a win/win!! The CCG benefits, as it addresses inappropriate admissions. The GP’s benefit, as it gives them a third option other from referral to hospital or to prescribe medication. The Voluntary and community sector benefit, as it supports their sustainability. And most importantly - the Patient and Carers love it as it improves quality of life, reduces social isolation and moves the patient from dependence to independence.

12. Key learning Points The need for key contacts, building and maintaining relationships and champions – get the CCG, GP’s and VCS on board Leap of faith – the importance of time and scale Role of lead bodies – implications for contracting and micro – commissioning Be prepared to be challenged and to challenge professional boundaries The vital role of KPI’s and quantative as well as qualitative independent evidence to argue the case 12

13. Case Studies 13 Three broad outcome themes emerged: Improved well-being: in particular mental well-being, anxiety and depression, personal confidence and self-efficacy. "If it wasn’t for the group, I might not be here now because I’d been that down and depressed….just getting out of the house has helped me with the fear, anxiety…talking to people lifts your mood and forget about problems at home." Reduced social isolation and loneliness: linking people with limited mobility and social contact with the wider community. "It’s someone coming to talk to me and with me and they acknowledge me…because you can sit and stare at space and people take no notice whatsoever…I feel like I belong to a society." Increased independence: linked to improvements in physical health. Includes undertaking in independent social and community action. "I was on my own, I was totally on my own…Each day I’m getting better and better…before I could hardly walk…I’m feeling very positive, each day I get up and I just can’t believe how much I’ve come on."

14. Social prescribing Mental Health To help service users overcome the barriers which prevent their discharge from secondary mental health care services. The programme helps service users build and direct their own packages of support, tailored to their specific needs, where they are encouraged to access services in the community and develop their own peer-led activities. 14

15. Aims and Objectives Creating opportunities for Mental Health service users (cluster 7&11) to sustain their Health & Wellbeing outside secondary Mental Health Services Creating more capacity within secondary Mental Health services Creating efficiencies within Mental Health services. 15

16. Cluster 7: This group suffers from issues associated with long term anxiety and depression or other non-psychotic disorders. They will have received treatment for a number of years and although their symptoms are improved and stable, as a result of long term ill-health they are likely to have a level of social disability that effect their day to day functioning, and leads them to be over dependent on others. Cluster 11: This group will have a history from a psychotic symptoms that are currently controlled and causing minor problems if any at all. They are likely to be experiencing a sustained period of recovery, but require support to regain confidence with day to day life skills, such as sustaining meaningful relationships, and re-entering the work place. They may also have some long term dependence issues. 16

17. Aims Of The Service Increase social activity Reduce social isolation and dependence Improve confidence and self esteem Focus on quality of life, positivity and happiness Support healthy and sustainable discharges from services and create capacity 17

18. Self Care Weeks 1-6 Cluster 7 Cluster 11 Discharge Ready RDASH Weeks 11-18 Weeks 7-10 Weeks 19 - 22 Guided Conversation Menu of Options Recovery Plan Wellbeing Advisor Joint Community SPS Sustainable Activity Social Prescribing for Mental Health Pathway 1:1 Keywork Peer support – group Peer support – individual Specialist support/advocacy Funded VCS Services Review and dormant Care plan issued Transition Group Review and discharge (SPS) Weeks 23 - 26

19. Positives A positive and productive partnership has been developed between RDASH and VAR We have a service that empowers teams to be more recovery focussed The individual outcomes of participants so far has been well beyond our expectations, and in some cases truly remarkable The opportunities that have been resourced via the CCGs commissioning of voluntary groups are diverse, exciting and delivered with infectious enthusiasm! We have no doubt that this is one of the best developments in service provision in a long time – it works! 19

20. Challenges We have underestimated the cultural shift required in both staff and service users to embrace the service and understand the opportunity that it provides – this has meant a slower referral rate than we hoped for but we are working hard on this The process of preparing service users for this new journey can be labour intensive, and this has created work pressures There are still barriers to moving on, regardless of rate of recovery (117, depots etc) 20

21. David Chronically anxious for most of his adult life. Fears death daily, becomes overwhelmed easily. Has tried all available treatments “David, you’re always going to be anxious, why don’t we focus on having a good quality of life despite your anxiety?” Through social prescribing David rediscovers a love of art, and begins an over 50s social group - “ I can’t explain to you why, but for three hours I was loving it so much, I forgot to be anxious” At his 10 week review, he encourages me to cut short my visit – “I don’t want to throw you out, its just that I don’t want to be late for my group” Discharge: “You hit the nail on the head when you said the words ‘quality of life’, that’s what I’ve got now” 21

22. Helen Gave birth to a severely disabled daughter at the age of 16. Cared for her 24/7 until she had no choice but to put her in to care 20 years later. Having struggled with her mood throughout – this decision plunged her further in to despair. Taken multiple medications over the years, and is still on a vast regime. House has been repossessed because husband is a gambling addict. Self – esteem is non existent and she is overwhelmed by guilt. 22

23. Helen (cont) Persuaded Helen that it was time to invest in herself – and she agreed to be referred. After a positive initial meeting – VAR advisor informs RDaSH that second meeting was less positive and she was not confident she would get to the chosen group. VAR Advisor decides to take her. Helen reluctantly attended ‘Radiance and Relaxation’ 23

24. Helen (cont) 10 Week Review: “ I was terrified about going back on my own – but I had loved it, so I had to go” “ There are steps up to the building, by the time I got to the top I was so anxious that I couldn’t feel my legs - but I did it, and I’ve kept going “ Discussed with Helen what she might do going forward. “ I want to be a helper at the group – I want to be the person at the top of the steps smiling, telling people that they don’t need to be frightened about coming in” 24