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Reframing the reform: Not what I can’t do, but what I can do

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By John Kennedy, Independent consultant and commentator in housing and social care

John Kennedy head and shoulderA we enter another of those regularly recurring cycles of “we really must reform social care” it may be useful to pause first and reflect on what we actually want. There is a danger that all the debate is around the money, surely you decide what you want first and then work out the money?

Shouldn’t we revert our framing of social care from one that puts its primary purpose as Care, to one that enables us to stay well? Not ‘what I can’t do’ but ‘what I can do, and indeed could do’!

There is now a good body of evidence and examples of the effectiveness of a Social Prescribing approach to enabling us to age well; frailty and disability aren’t an inevitable consequence of age.

But what do we mean by Social Prescribing?

There is no one definition but this descriptor from The King’s Fund I think characterises it well.

So why don’t we start by looking at what works.

A recent study, also published, by the King’s Fund and the University of York, looked at the evidence base which has emerged of the positive health and wellbeing outcomes for older people living in retirement villages and extra care housing.

It finds strong evidence of significant systemic benefits, as follows:

 

  • Reduced visits to GPs
  • Reductions in use of community nursing services
  • Reduction in length of hospital stays
  • Reductions in hospital admissions
  • Reduced ambulance and emergency call outs
  • Reductions in care and care equipment costs
  • Reduced likelihood of entering a care home or other long-term care

The study also found significant benefits for individuals living in these settings:

 

  • More exercise, fitness and independence.
  • Better perceived health.
  • Reductions in falls.
  • Reduced frailty.
  • Increased life expectancy.
  • Lower levels of depression, loneliness, isolation and anxiety.
  • Improvements in memory and mental function.
  • Improved sense of community and wellbeing.
  • Reduced cognitive decline.
  • Better contact levels with friends and family.
  • Improved confidence in self-managing health.
  • More of a sense of control for residents.

These positive results are not accounted for by medical interventions, but are the result of much more holistic, people level model.

This is Social Prescribing in action – a much wider view of an individual’s wellbeing, taking into account the social determinants of good health, addressing loneliness, isolation, inactivity, and poor housing. The list can go on.

The evidence is strong and makes a compelling case for specialist housing to come into the mainstream of social care policy. Of course, not everyone wants to live in a retirement village but evidence from other countries suggests that approximately 6-8% of the older population find it an attractive option in later life. We can learn from these findings and use the evidence for energising a reimaging of neighbourhoods and the impact they can have through the medium of social prescribing.

There are a number of exciting approaches.  One I came across whilst working in Northern Ireland is the CLARE scheme. If you have eight minutes to spare, I recommend this video.

https://www.youtube.com/watch?v=zJuHgxbywnk

In England to Community Circles are doing similar work at a neighbourhood level.

https://www.community-circles.co.uk

If we reimagine our social care system as being one that enables wellbeing based on a ‘what can you do’ as opposed to ‘what can’t you do’, the outcomes may well be far more positive.

Good housing, physical activity, good food and good company keep us well whether you’re in a retirement community, Extra care housing or in your house in your street.

Keeping us well is good for all of us, good for managing the demands on NHS services, good for reducing the demand for formal care services.

We need to ensure that the barriers to a more widespread neighbourhood-based care infrastructure are removed. Whether that be through the planning system or the way services are funded.

So, let’s invest in housing and neighbourhoods and have a vision of social care that’s driven by health.

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