How social prescribing can help your mental health and wellbeing

Welcome to the very first episode of Aviva Talking Health, a brand new podcast from Aviva. I’m your host, Gordon Rutherford, and in each episode we’ll be getting to the heart of the most important health and wellbeing matters in the country today. Now, before we go any further, it’s important to note that everything we discuss on Aviva Talking Health is general information only and not medical or financial advice, and that is very important. 

Of course, I can’t do this alone, nor would you want me to. And I’m delighted to introduce Aviva Talking Health’s resident technical and medical expert, Aviva’s Medical Director, Dr Suba. Hi Suba, how are you? I’m brilliant. Thank you. Gordon. 

Today in this inaugural episode, our topic for discussion will be social prescribing. And to help us make sense of that. I’m delighted to welcome Charlotte Osborn-Forde, Chief Executive of the National Academy for Social Prescribing. Charlotte, welcome. Hi, Gordon. Thank you for joining us. Thank you for having us. 

So let’s get cracking. But before we dive into the fine details of social prescribing, I’m conscious that there will be viewers out there who are wondering why Aviva are doing this series and more specifically, why we are talking about social prescribing. So, Suba, help us out. Why do these things matter to Aviva? 

That’s a great question, Gordon. We provide insurance products to our customers throughout their different life stages in everything that kind of matters to them. And we also are a long-term investor in the UK. We’ve been here for 325 years. And through the conversations we’ve been having with our customers as well as colleagues, especially at the moments that matter when our customers contact us. We know that health is a foundational thread that runs through every aspect of that. And social prescribing is a topic and a tool that really helps us to open up and broaden the discussion about health being not just one that in terms of accessing at hospital or GP surgeries, but one that is impacted by wider determinants of health. So things that actually happen in your home, as well as the daily decisions that you make, especially financial ones. So as Aviva’s ambition to support people, to have happy, healthy and productive lives absolutely aligns with what social prescribing is trying to do. Thanks Suba crystal clear. 

Charlotte, many people are going to be in the same boat as me, and they won’t actually know what social prescribing is. So tell us, what is social prescribing and who are the National Academy for Social Prescribing? Well, yes. You’re not alone in not necessarily knowing much about social prescribing, but it’s grown hugely over the last few years and more and more people are interested in finding out more. So social prescribing means it’s an approach which connects people to community groups and services to support their health and wellbeing. We talk about the four pillars of social prescribing, to help people make sense of all of the things that can be accessed through it. And the four pillars are: Nature, so that would include things like, walking groups, nature conservation, gardening. The second is sport, leisure and physical activity, and that can be a sports group, leisure centre, tennis. But even things like Nordic walking that people might not have thought about. Third is arts, culture and heritage. So that’s everything from art groups attending special sessions at the theatre. Music activities and engaging in heritage activities which promote wellbeing. And lastly, and probably the largest and most important is the practical support and advice. So, this is all of the work of charities and community groups that help with things like poverty, housing, debt and finances and help people feel more socially connected. And the National Academy for Social Prescribing, we’re a charity and we support the health service, the community sector and many other partners to understand social prescribing, to make sure that it grows in an evidence based way, and to help more people, both to access social prescribing and more staff in the NHS to deliver social prescribing to help more people. 

And until recently, I had never heard of social prescribing is it a new thing? Social prescribing is absolutely not new, and I’m sure we can each think of the things that we might do in our lives that support our health and make us feel well and better. And doctors in the health service have always recognised that medication alone can’t solve many health conditions. So, in the 80’s and the 90’s, we saw doctors start to embed different community activities within their GP practices. And that grow and extend. And it was about 15 years ago that it first became picked up by the Department of Health and included in national health policies, but it was in 2019, with the last NHS long term plan, that social prescribing was really defined, and systems and processes embedded and then it was rolled out through the GP contract. So, it should now be available in every GP practice in England. Okay. That’s really interesting. 

So, I mean broadly speaking how might someone access social prescribing? And who are the key people involved? So, in England and I must say social prescribing is around the world. And it sometimes looks different in other countries. But in England it’s really led by the social prescribing link worker. And this is a new NHS role. And they are very unique within the NHS in that they sit both within the healthcare service and typically within the GP practice, but also in the community. So, they’re sometimes known as community link workers. And what they will do is help patients that are referred by their GP, by their doctor or nurse or other parts of the health system. They will help them, think about what could make a difference to their health and well-being, and then all of the things that are available locally and help them to access it. 

Can you give me an example of a link worker? I mean, might they be someone that I know? And I’ve come into contact with? Well, yes. So there are at least 3000 link workers in GP practice and probably more again in other community services. And they come from all sorts of different backgrounds. So you may well know a link worker, it might be your neighbour or a former colleague. And they could come from a health background or a community background. But what’s important is that they are able to listen to people, support them and understand their needs. 

So I want to move on now and look at where social prescribing sits within the broad spectrum of health care. So I mean, unfortunately at the moment we seem to be living in a world where demand for mental health support is ever increasing. Where does social prescribing fit within the context of all the available treatments for mental health? It’s a really good question. So recent reports suggest that about 1 in 6 adults experience common mental health disorders, such as anxiety and depression. And we know that about 15% of working age adults actually have a long-term mental health condition. If we think about mental health in the traditional format, we might think about solutions and interventions as talking therapies through psychologists or medications through psychiatrist, you know, anti-depressants and such. And but if you think about mental health and the cause for it, there’s multiple reasons as to why somebody might be struggling with it. Some of it is actually financial stress, you know, debt, you know, addictive behaviours or social pressures in terms of family, kind of like, issues. So, all of these different issues can be solved with some of the interventions, the medical interventions. But actually, if you step back a bit and think about what is the root cause of it and how do you really support individuals through that? Social prescribing gives you another tool in the armament of what you can actually use to try and help people. Thanks, Suba. 

Charlotte. If I play the patient role, let’s say I’m an individual with more complex mental health needs. I know that we can’t give specific medical advice in this podcast, and I know that you wouldn’t want to anyway. But broadly speaking, will social prescribing provide what I need for better mental health and wellbeing? Social prescribing can be a really effective tool for anybody, whether they have, less serious mental health problems or for people with more serious conditions. As long as they’re accessing and receiving the right clinical support that they need to. Social prescribing on its own, it’s never going to be a solution to someone with a complex medical need. They, of course, need the other parts of the health system. But it can just, as you said, augment and support. And I’ll give you an example. There’s a community programme I used to work alongside, and people were referred by their psychiatrist to this community programme, often with those more serious mental, mental illnesses. They were receiving the support from the secondary mental health care, but they came out into the community and they would do volunteer gardening. They would do other sorts of practical things. And we did an analysis of this project, and we, we heard from people that it really improved their sleep because they’re outside. They’re getting daylight. It help them set a routine, which really made a difference to their life because instead of thinking, that just, you know, needing to get up in the morning a reason and the volunteering, giving something back really improved their self-esteem. So it can be very challenging having serious mental health conditions, particularly if you’re unable to work. So, that’s an example of where, when it’s properly integrated and there’s good partnership working with the NHS, social prescribing can be hugely effective and core part of a service for somebody with more complex needs. Okay. Thanks, Charlotte. 

Any thoughts on that, Suba? Yeah. I think, the gardening example really stood out to me Charlotte. Because actually, Aviva, as we’ve done a story of the health, Story of Health Report, and we found that specifically in the 25 to 34 cohort of, like, individuals of that age, over two thirds consider social prescribing as an alternative to medication. And they really wanted to kind of be out there, enjoying greenspaces and nature. And actually that even if you look at all age groups, 58% of everybody kind of, that we interviewed for this particular survey said that they were open to social prescribing and that’s already in that prevention space, and they can already draw that connection between mental health, staying active, being connected and being outdoors. 

And that’s why link work is all really important, because part of being a link worker means sitting down with a patient, having time with them and helping them unpick, well, what did they enjoy as a child? How physically active are they and would they like to be? And what are their interests or passions to help them find a motivation to doing more in the community. Because sometimes when you do have a health problem, particularly if you’ve got other potentially financial issues and other sorts of barriers, the last thing you can think about is, joining a sports group or a walking group, whereas a link worker will help somebody unpick all of that and then think about, well, what’s really going to get you out of bed in the morning and make you feel inspired, and then really a personalised plan to do that. Suba, we’ve already spoken about the rise in demand for mental health support and the UK. What’s your take on how the government are supporting that? The things that I wanted to call out, which I thought was really good, was the government’s ten year plan. And they talked about, major reforms and new investment. So, things like, you know, improving and increasing the number of mental health workforce. Also addressing the, concerns of, you know, the more acute and like, mental health A&E where it’s actually trauma informed and in a more caring kind of like position for those who are in a acute state of distress. But the thing that really stood out to me, of all of the things that they kind of mentioned, is that three shifts that came out in the NHS ten year plan. So, which is, you know, going from hospitals to communities, from intervention to prevention, as well as analogue to digital. I’ll put the analogue to digital side aside for a minute, because that’s actually quite an interesting conversation, separately. But the way that we’re talking about mental health in upstream prevention and in community absolutely ties in with what we are talking about here. So, I think the government is really keen to try and address this because, as I mentioned, the disease burden of mental health is increasing. And so how we organise our health service and how policy needs to, kind of shape the conversation that we have nationally about health and access to healthcare and even the cost of it, because that is something that we need to consider. Is is kind of moving in a positive direction I think. 

Charlotte, here we are today talking specifically about social prescribing. How are the government supporting that? Well, as I say, social prescribing became officially part of the NHS back in 2019. So, there is funding through the Department of Health and down to GP practices. And it’s part of the GP contract. So, what the GP contract says is that GP practices must offer social prescribing service to their patients. And GP’s can draw down funding to cover the cost of linked workers. Some data from University College London showed that over a million people a year of being referred by GP’s, for social prescribing services and to see link workers. So, there’s already this, this mechanism, that is ultimately funded by the government, various other initiatives and developments to support social prescribing. A recent government funded program focused on mental health, was called Preventing And Tackling Mental Ill Health Through Nature Based Social Prescribing. And that was really a sort of test and learn project to explore how we can embed social prescribing more into health services, particularly thinking about environmental activities that people can do. And that was externally evaluated, and it’s given us some amazing data to further embed social prescribing in the health system. So that all sounds fabulous, Charlotte. However, I understand that there are challenges around the effectiveness of social prescribing. One 2023 report by the Department of Health and Social Care about green social prescribing, in particular, suggests that link workers do not have sufficient training to adequately support. And the report states that there is a worrying pattern of link workers and green activity providers receiving patients with complex mental and physical health conditions that they are not equipped to manage. 

What’s your response to that, Charlotte, and what can your organisation do to minimise the risk? Well, that does happen. So, we do hear of patients with more complex mental health needs being referred into the community and to link workers who haven’t necessarily had, all of the training in more severe mental health conditions. And so, exactly as we were saying earlier, it’s really important that social prescribing is integrated with medical care, with clinical care, and that people who do have a higher level of need are accessing all of the services they’re entitled to from the NHS, as well as being in the community and accessing social prescribing. It will never be a complete alternative for somebody with serious mental health needs. It will still need, the support of their doctor. What we need is excellent training for link workers, but particularly as that report picked up more training for community providers, for charities, for community groups. And that’s really why the National Academy for Social Prescribing was founded and developed, to increase the learning and the training and the awareness and why, for example, we’re really pleased to be working with Aviva so that we can upskill, link workers and those in the community. Excellent. Thanks, Charlotte. Earlier you spoke about data and data being developed. And, you know, I guess the big question around effectiveness says, does social prescribing actually work and what data exists to support that? Well, yes, we now have an incredible range of evidence. So, both academic research and data. We work very closely with University College London. And we have set up the National Data Centre for Social Prescribing with the university to, track and analyse data both in the health system and through community providers as well as the growing academic research, and it is incredibly powerful. So, for example, there is research looking particularly at patients reported wellbeing. Do they feel happier? Do they have reduced anxiety? And as you would expect, yes they do. Typically seeing improvements of 20 to 30%. We have data on the impact of the health system. So the National Academy published a report at the end of 2024. We analysed NHS data from nine different NHS sites about social prescribing and whether or not patients who’d accessed social prescribing actually needed to use A&E less, or their GP. And although the different sites were all very different, many of them saw quite significant reductions between 5 and 20% reductions, and some actually had control groups where they track patients with similar conditions, but who hadn’t access social prescribing. So that’s really encouraging, this body of data is showing not only to patients, and people say it’s making a difference to their wellbeing, but we can actually see the changes in NHS data. 

Suba I’d like to turn to you for the next one. An opinion article published in the British Medical Journal in 2023 claimed that social prescribing is no remedy for health inequalities, and this was something we touched on a little earlier. And, so if you do happen to live in a less affluent area on a hard to reach part of the community, are you unlikely to have equal access to social prescribing groups? Does it exacerbate health inequalities? I don’t think so. What I think it kind of shows is that it’s not for the social prescribing link worker to kind of create this, social infrastructure. You know, the infrastructure needs to be there for them to be able to connect and link up individuals with solutions. And it is true that, you know, in, areas where it is less invested in, there probably is less kind of community-based solutions available for them. And this is one of the reasons why I feel really strongly that health is not the solution, doesn’t need to just come from the National Health Service or government. I think every single, you know, organisation has a part to play. 

So an example, an organisation like Aviva. So we’ve done the partnership with business in the community as well to try and invest in community building, capacity building, going to areas where there is a greater need for businesses to really push themselves forward to support that. So, I think what social prescribing can do is obviously draw those links up. And I think organisations beyond the government can really support in building that infrastructure to make sure that the social prescribing workers can augment the services people in more deprived areas can access. So I think it’s a bit unfair to kind of expect social prescribing to be the kind of like, silver bullet that addresses some of these health inequalities. What social prescribing can support with is really understanding an individual, right. So if you’re talking about going and exercising or going to green spaces culturally, there would be certain kind of, misconceptions or preconceived notions about what an individual or a community can access or should access. So, I think having a link worker who really understands the community that that kind of cultural nuance that, you know, individuals might have about, you know, going to the museum or not. I think that really helps to have a richer, deeper and more personalised conversations. That means that some of these services can be better accessed, by individuals who are not traditionally accessing them. The last thing I’d say is green spaces. For example, we talked about green spaces. There’s not enough parks and green spaces in kind of, more deprived areas, perhaps as transport systems to get to these solutions is not kind of as well developed. But it’s also about how safe people feel in certain green spaces. So just because something is there doesn’t mean that people will access it. No thanks. And Charlotte, your thoughts on that? 

The whole purpose of social prescribing is to provide additional support for people that would not otherwise be able to, or naturally connect into their local communities. It’s literally designed and tailored to support people who are potentially more vulnerable, socially isolated, lonely or with complex needs who are struggling to navigate what is out there. So when you look at it through the frame of it being a personalised, support for people, that really helps them to access things that will make a difference, then it does directly address inequalities, because if you are a well-connected, affluent, confident person, you will know what’s available in your community and how to get to it. But if you aren’t, social prescribing is a way of helping you take part in the community and helping you access those things that you’re entitled to. And so what we see actually, is that really does show up in the data. So University College London has published a report looking particularly at, health inequalities and deprivation. They analysed data of about 160,000 patient records. And they found that, the poorest people. So in the top 10% most deprived areas were more likely to access social prescribing than the least deprived. So the people living in the most wealthy areas. And I was really heartened when I read that and saw that data, because that’s exactly the experience that we hit all the time, where link workers are telling us, actually the people we’re helping are people in real crisis, and they’re very typically in, in not just poverty, but having other serious problems and issues and very isolated. So I think we’ve moved on a lot, even in the last few years, where we now have the robust evidence that shows it’s tackling health inequalities. And we have the patient stories. I’m going give you one more challenge on the effectiveness question. There has been some press coverage that is a little negative. Why do you think that is? It’s a very new, exciting and really powerful initiative that so many people are talking about. So of course it’s going to be featured in the media because people are, oh, what is this thing? Is it good? Is it bad? And like any new initiative that has got government backing, quite rightly, there’s scrutiny. Is it the best use of taxpayers money? But actually when you look at the facts, you can see that, the NHS is funding link workers, who are these specialists to support the most vulnerable, to benefit from things in the community, and that it is directly improving their health. 

So the NHS is really confident that this is the right thing. So it’s really important that when we read that, we recognise that they’re not saying there’s evidence it doesn’t work, they’re saying there’s not enough evidence and we need more investment in research. So I think, it’s very important that we actually read the facts before we make these assumptions. Indeed. And it’s like one of the other quotes that I read when, when I was, before that, when I was researching and it’s, you know, the evidence, the effectiveness is not proven. Now, not proven is completely different from it doesn’t work. So that’s something to bear in mind. 

So let’s move on and paint a brighter future. What is the future of social prescribing? Well, as Suba’s explained, we now have a new NHS ten year plan and the three shifts in that are really evident and that is from hospital to community, from sickness to prevention and from, analogue to digital. And actually, social prescribing is, is in all three of those. So of course, moving hospital services out into communities, but recognising that our health sits within our community, within our neighbourhood, and that it isn’t just the medical side that can support us, but the strength of the community. And of course, from sickness to prevention, recognising that, we can maintain and support our health, we can prevent ill health through being socially connected and physically active and creative. And actually, social prescribing is explicitly mentioned in the shift from analogue to digital and thinking about how digital tools can help us better know what’s available in the community and connect into it. So, we really feel that social prescribing is a practical tool and mechanism to help the NHS achieve those big strategic vision shifts. How do we move from sickness to prevention and how from hospital to community, well, social prescribing, something that’s happening already. It could be a lot bigger, it could be expanded. But it’s a really powerful tool to help the health system benefit from all of that community support and from all of the volunteers and groups and services that are out there supporting people. 

So the future’s positive. Yep. Cool. So Suba. We always like to translate the benefits of something like social prescribing and the pounds, shillings and pence as a way to demonstrate financial effectiveness. I think at the moment we look at the financial effectiveness, well clinical effectiveness and cost effectiveness before the and National Health Service will consider something as part of their, toolkit of what they actually offer. One of the issues that we’re trying to still grapple with as a society is the time horizons in which we are hoping for the payback, and who actually pays for this. There’s an economic kind of argument to be made about keeping people at work, for example. And also, what is the time horizon in which you’re expecting the results of some of these interventions? And things like prevention, it’s not going to come back to you in first, second or third year. There’s definitely some kind of evidence that it does, but it’s usually a much longer-term kind of like play. So I think that’s one of the lookouts for me when you’re trying to, you know, box something that’s quite intangible, like community spirit into pounds and pennies. No thanks. And Charlotte, your thoughts on that? So we’ve done a lot of work on this at the Academy. How do we demonstrate that, that, economic value. One way is to see whether patients are using less NHS services and then to cost the value of that up. And we do see that the financial value when we do that. But the other is the quality-of-life adjusted year mechanism. So the Treasury have actually recognised that life satisfaction does have an economic value. So, there is a certain, calculation that you can use if you can prove that you’ve improved somebody’s life satisfaction and you can do that through a questionnaire, asking people, how satisfied are you with your life nowadays? And if that does improve, legitimately, over three months or six months, you can actually, allocate a financial cost to that. And what we’ve seen is, social prescribing starting to do that analysis, which is really exciting. We’ve got a couple of examples who’ve done it for, a large number of patients. And the numbers that are emerging from those calculations are really exciting, because they’re much lower than other NHS interventions that might use that, financial proxy to measure their value. So I think this is a new area for social prescribing, very important. And we’re seeing all of the time that when you do apply these quite complex financial process to it, it more than holds its own against other interventions. And Suba turning to you. Aviva are obviously a major provider of health insurance schemes to some of the UK’s biggest employers. So, what can businesses learn from social prescribing and how do they integrate that philosophy into the working lives of their employees? So if you think about, you know, community being something, that actually happens in a workplace as well, you know, because we have digital communities that people connect with in different ways. You’ve also got that anchor institution type of community. So each business is actually a micro community in and of itself. And we know that line managers, for example, have you know, outsized impact on their kind of direct reports, mental health, for example. So social prescribing really opens up and is a way of thinking about health in the most broadest sense. So health, you know, where you work, the learning opportunities that you have with work, the connections that you have with your colleagues, all of that ladders up to your mental health and in some cases physical health as well. And participating in the workplace, obviously, you know, gives you that income and also a purpose. So, so for me, workplaces are a microcosms of external communities, as in geography-based communities. And so the principles of social prescribing applies in the sense that, you know, the employer would have, like the government has, various different solutions. The employer has various solutions like employee assistance program, private health insurance, or, you know, access to mental health services or physio services, occupational health. So there’s a range of things that’s available to individuals in the workplace that align manager or a wellbeing manager within an organisation can help signpost. Can employers refer employees to a link worker, for example? So, the way of accessing it, the employer can signpost their, team member, colleague or employee to the NHS GP services and then they would be able to kind of connect up with a link worker. But it’s more of a signposting as opposed to a referral. 

Thanks Suba. So, we’re almost there. Time flies and we are nearly out of it. But before we go, if you wanted our audience to take away one thing very briefly today about social prescribing, what would you say? Suba you first. I’m going to say two things, Gordon. So, as you know, the first one is more theory. So be curious. Go find out a bit more about it if you haven’t heard of it. There’s plenty of resources there. The second thing is a bit more practical. So, you know, it’s about community and connection to be part of the community. Be curious and reach out to individuals who are around you. Maybe, you know, have that in a creative itch that you want to scratch. Do that, go outside, you know, enjoy green spaces. But equally, if it’s something that is of interest to you, go speak to your GP to find out a little bit more about it. Thanks Suba brilliant, practical advice. And Charlotte? Social prescribing is the future of health care. So we all know that medicine alone can’t solve all of our health problems, and social prescribing is a way for you to access all of those amazing things in the community that can make a difference. So find out more. Thanks Charlotte. 

Sadly, that concludes this episode of Aviva Talking Health. I would once again like to thank our special guests today. Our experts, Charlotte Osborn-Forde from the National Academy for Social Prescribing. Thank you, Charlotte. Thank you Gordon. And Dr Suba Aviva’s Medical Director. Thank you, Suba. Thank you Gordon. And thanks to all of you for joining us today. You can find further details about social prescribing on the NHS website. At Aviva.co.uk. And obviously on the NASP website or, of course you can ask your GP. Now please remember if you are experiencing poor mental health, please check NHS guidance or speak to your GP. Thank you so much and watch out for our next episode.