What is known about this topic and what this paper adds
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During the COVID-19 pandemic many people have suffered hardship
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Social prescribing is being rolled out across the UK to support people with long-term needs
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A consistent, trusting and positive relationship with a link worker is central to successful social prescribing
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During COVID-19, this social prescribing service was able to adapt quickly to remote delivery but faced challenges, including accessing digitally excluded clients
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Some clients received greatly appreciated support while others felt that their social prescribing journey was ‘on hold’ or ‘going backwards’
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Link workers’ abilities to detect changes in people’s lives were paramount to successes of social prescribing during the COVID-19 pandemic
Background
Methods
Context and the intervention
Recruitment
Data collection
Data management and analysis
Findings
Participant characteristics
N | |
---|---|
Gender | |
Male | 19 |
Female | 25 |
Age | |
40–49 | 6 |
50–59 | 11 |
60–69 | 17 |
70+ | 10 |
Ethnicitya | |
White British | 38 |
British Bangladeshi/Pakistani/ Indian | 6 |
Income | |
< 10 K | 13 |
10-20 K | 14 |
21-30 K | 6 |
31-40 K | 3 |
> 40 K | 4 |
Employment status | |
Prefer not to say | 4 |
Full-time (FT) employment | 4 |
Part-time (PT) employment | 8 |
Furloughed | 2 |
Unemployed | 13 |
Retired | 17 |
Benefits claimedb | |
None | 20 |
Health-related benefits | 18 |
Means-tested benefits | 6 |
Number of LTCsc | |
1 | 9 |
2 or more | 35 |
Household Structure | |
Lives alone | 12 |
Lives with partner | 17 |
Lives with family < 18 yrs | 10 |
Lives with family > 18 yrs | 4 |
Multigenerational household | 1 |
Housing Status | |
Owned | 26 |
Rental (Private or social housing) | 17 |
Other | 1 |
IMD quintile of home address | |
1 (least deprived) | 6 |
2 | 4 |
3 | 9 |
4 | 5 |
5 (most deprived) | 20 |
Service providers
Intervention adaptations to COVID-19 crisis: March–June 2020 | |
(LWC_31_06/20) | … We’ve been given shielding lists by the practices, so the people who are vulnerable, we’re checking on them, but that is not our normal conversations again. That’s just like, “Do you have food and medicine?” if you know the guidelines, stuff like that … checking that people are okay and they’ve got access to food and medicine, that they’re coping with it mentally and they know what they should be doing. |
(Manager_3_06/20) | The type of support that we have been providing has changed slightly as well, in the early days. So, people were very worried and concerned, naturally, about COVID and what the likely impact that would potentially have on themselves and their health. They needed information around what they could and what they couldn’t do. So, it was just really to help them understand what the government was saying. So, a lot of time, initially I think, was supporting people around understanding of what the lockdown restrictions meant for them and finding out what support they needed. Because obviously, a lot of people don’t have family or friends and if they are shielding or isolating, they can’t go to the shops to get their shopping and stuff like that. |
(Manager_4_05/20) | So, if you have improved your condition by getting out a bit more and feeling more hopeful and enlightened by that, and now you have been told you can’t go out, then there will be that bit- It is much easier to do something the first time than if you have gained some success and then slipped back. So, it is that bit of just trying to help people wherever possible not to lose the ground that they have gained. |
(Manager_2_06/20) | I think the priorities initially were right, you know, checking in on the people in our current caseloads, making sure they had contact, and whether there was anything that they needed- that sort of immediate support-, or they still wanted to engage with ongoing support … Whilst obviously it has chucked everything up in the air for everybody, you know, still using our skills and our knowledge to be able to support people to manage this as best they can, and identify if there are goals, although they will be reframed, to still be able to work towards that even in the current climate. |
(SLW_32_06/20) (Manager_8_09/20) | The nature of our role is that we are very flexible and we maintain contact. It is very much a contact role and a communication role. I think that is important for people who have been self-isolating and haven’t left their homes. Some people: maybe the furthest they have gone is the garden. It is reassuring to know that you are ringing, they can contact you or if they are having problems with things, that you can ask the right questions to the right people and you can feed back information. Even if you haven’t got the information at the time, to be able to tell them that you are still waiting for information, but you have asked the question. I think that gives reassurance at a very difficult time. I think that is definitely a strength … there was a sense that people were like, “Why would I discharge them at a time when everything in their life is up in the air?” So I think there was a sense that they were, kind of, keeping things open for a little while. I don’t think that’s the case anymore [in September]. I think things feel more stabilised |
(Manager_2_06/20) | I think there was getting that balance between, “Here are the people that I know that I’ve been working with that I would identify as a priority.” But actually recognising that it was important for us to try and check-in with as many people, if not everybody, on our caseload to try and see what the impact of this situation was. |
(Manager_1_06/20) | So we also had discussions with them about understanding on the caseload, people that actually probably didn’t need our support. Just to be able to discharge, for want of a better word, people that probably were coming to the end of their intervention with ourselves so we could really focus on those that really did need our support. |
(LW_9_06/20) | But because of the current situation, I haven’t closed them or anything, because of the current situation. |
Link worker innovations and challenges with remote delivery to clients | |
(LW_9_06/20) | if you’re not digitally connected there’s an obvious gap for a lot of our clients’ |
(LW_33_06/20) | Some of our clients aren’t particularly tech-savvy. Some are on the internet and doing FaceTime with grandchildren and all that kind of thing, but I do have … Fairly recently … I’m finding this a challenge and I’m finding it difficult to know how to overcome really. I do have a couple of clients that are unable to read or write. Ordinarily, where I’d be sending an email with some links to websites or something like that for information during this time or even posting out something, printing something off my own printer, I don’t have that option with these two individuals |
(LW_31_06/20) (LW_31_06/20) | The transition to phone calls has been difficult, because even though we do that anyway, when we first do a [assessment] with someone, the face-to-face of that is so important because you’re introducing yourself, what the service is. You need to build that rapport, otherwise people aren’t going to open up to you. So, introducing that over the phone has been quite hard. Then everything has changed, so you can’t see what people are doing body-language wise, face wise. We’re told to hold silences, but that is very different over the phone “things aren’t open, so things that I might like to signpost people to, I can’t.” |
Perceptions of client engagement during remote delivery and a crisis | |
(SLW_32_06/20) | The people who I have spoken to don’t express an interest in anything like that [online activities]. I mean, a good example would be a client who was attending Slimming World. He mentioned about the Zoom facility that Slimming World that have and he said it didn’t work for him. It wasn’t the same as actually going to a group, seeing people and talking to them. This 2D representation, if you like, wasn’t the same as having that actual social contact. |
(LW_33_06/20) | Some clients are like, “Oh, I prefer face-to-face because then I can see your facial reactions and your body language and all the rest of it.” It’s the same, I guess, for us, because we can’t really see how things land. If we’re saying something, a lot of the communication cues are visual rather than verbal. |
(LW_9_06/20) | People who haven’t answered the phone are now answering the phone and they’re wanting to chat. Now that is brilliant, because a lot of people … who wouldn’t have wanted to come to the doctor’s surgery [to visit the link worker], or find it difficult … they will happily chat on the phone for half an hour, an hour, and they’re really engaging at quite a good level with that, they’re someone who is DNA [did not attend], coming to the doctor’s surgery before. And when I’m now chatting to them, it’s obvious that actually to physically come to the doctor’s surgery is difficult. |
(LW_9_06/20) | nearly everyone picks up the phone immediately, and they want to talk to you, they haven’t got other stuff going on. So that’s been amazing. (Laughter) Partly because a little bit of their worries and stuff- They are quite open to ideas to benefit their health, because actually they’re a bit frightened. … I think the COVID thing has opened up people to a whole load of different new ideas. I kind of sense that a bit, that some people are just thinking, “Oh, I’ll give that a go.” It’s like opened up a different intensity about their health almost, that they’re now thinking that there might be other ways of doing things, and stuff |
(SLW_32_06/20) | We are very social and there is a big social element, I believe, in motivation. For example, if somebody wanted to talk about smoking cessation, we would discuss realistic approaches and, maybe, reduction with a view to them moving on to cessation. I find that that can be quite difficult because people may be motivated to want to change, but not having that contact as well... That contact can be reassuring. “Oh, I can go and see [Link worker] at the GP.” They can book the appointment and come in and see me, have a chat about it and have a real face-to-face conversation as opposed to over the phone. |
(LW_31_06/20) | they [clients] don’t really care about behaviour change at the minute … I think people just don’t really want the conversation that we want. They’re happy to talk with someone because they’re so bored-“I think it is just trying to stay on track of what we actually are, which is a behaviour change service. …. So, even if we’re not doing the conversations like I said, not all focused on behaviour change, we’re still speaking to someone, listening to them and if they do desperately need anything, we can signpost them to that. That is the main job of social prescribing, doing the signposting. |
Intervention adaptations to the COVID-19 crisis: march–June 2020
Link worker innovations and challenges with remote service delivery
Link workers’ perceptions of client engagement during remote delivery
Clients
Varied contact with link workers | |
Jude_60–69_Unemployed_IMD 5_lives alone_2 + _09/06/20 | No, the last time I heard from her was the beginning of the year, it was either January or February. It was before my tribunal, because she said, “I wish you luck,” and that. And then the lockdown happened just after that …. No. They’ll not be working, will they?... I’ve got her phone number, if I need to ring … You know, if I need to ring them, I could ring. But I haven’t. Well, like I say, everybody is on lockdown, so … There will be a lot of people that aren’t back at work yet, you know. I didn’t expect anything anyway at this time. |
Jessica_40-45_full-time employment_ IMD 5_lives with family-2 + _18/05/20 | [Name of link worker (LW)] telephoned me and I had a good conversation with LW. And then, as I say, she emailed me some resources and things over, as well, so that was really helpful … Just regarding my diabetes and some bereavement information for [daughter], as well …. Yes. We arranged to speak again … we said we’d leave it six weeks from our conversation, so it will be June, yes …. We’ve set a couple of targets, and I thought that gives me time to get my head around it and get going with it. (Laughter) … I’ve discussed actually with [LW] that, when we did the outcome star and things, we both said that- I think [husband] and I support each other quite well, and I think that really helps, I do feel like I have a lot of support from my husband. |
Eddie_50–59_unemployed_IMD 1_lives alone_2 + _06/07/20 | He called, [LW], a couple of weeks ago I think …. [intervention], yes. Just a catch up thing, and he got this organisation to come down and drop off a little food parcel thing …. that’s the only time I’ve heard from them … He called me out of the blue. I hadn’t heard from him for a little while before that … .he delivered three of them [foodbank vouchers at the start of lockdown] … I used two of them. I wasn’t up for going for the next one. |
Gill_60–69_unemployed-IMD 1_lives alone_2 + _shielding_06/07/20 | I thought that she was the kind of person that I could actually talk to because I was really, really nervous on the way there because- like I have said, I don’t care much for seeing people who I don’t particularly know very well. But, I knew I had to go and then I found her manner was just exactly what I needed. She wasn’t condescending or she wasn’t pushing me to do things that I really didn’t want to do at the time, and she has been quite a valuable person to me, ringing up and seeing how I am and things …. Well, it is somebody I can talk to who knows exactly what I have gone through, you know …. When she rings up, I always feel a lot better after I have been speaking to her … But especially at the time where I was going through the devastation of losing Jim and everything, oh, she was just brilliant, you know. She has given me so much encouragement and she tried to get me to see a positive side of things, as well, you know |
‘Just waiting’: social prescribing ‘on hold’ | |
Derrick_60–69_Employed part-time_IMD 1_lives alone_2 + _18/06/20 | I’ve had a few interviews [with the LW] and stuff and they said they’re going to try and get me into a gymnasium. But with everything closing down and stuff- Swimming and stuff for my legs … So yes, I’m just waiting for that now … When the virus started, I’ve had a couple of phone calls off a lad, a man, but I don’t know who he is. But he was asking how I was and stuff like that, and how I’m coping. And they’re going to keep in touch … But with this virus, there’s not much they can do. Because their hands are tied with what they actually can do. Because I can’t actually go and physically see them one-on-one … if I see them one-on-one, it’s a lot better, I’ll get my point across a lot more, because I’m actually talking to another person, than being on the phone. Like telling them more, if you know what I mean, like face-to-face … So I hope, once this virus is over, I actually go down there and have a one-on-one interview with them and discuss what I’ve been doing through this virus and how my legs have been and how I’ve coped at work and stuff like that, just see what can be done. |
John_50–59_Employed full-time (pre-lockdown)_IMD 3_lives with partner_2 + _shielding_28/05/20 | Since this started [COVID-19], I’ve put the weight [on] … There is just no exercise whatsoever. It [the intervention] was great. The guy I was talking to was brilliant. [link worker name]. I’ve forgotten his second name. Everything started working. I gave up smoking and I was losing weight and then COVID-19 entered the scene and just ruined everything … .. Just the guy I was talking to was brilliant and that. His opinion and perspective …. He told me that I’m being too hard on myself. Yes, it was really good …. He [another link worker] phoned up a few weeks ago just to see how I was doing. He was alright. It’s a different guy. It changed. The last time I was there it got changed. He′s not as good as the first one, but he’s alright …. Just [spoke about] the same sorts of things. Smoking, putting weight on, state of mind … For me personally, no [not keen on online exercise classes]. I need some motivation. I need to be at the gym with somebody telling me what to do. |
Losing contact with social prescribing: Struggling and going ‘back to square one’ | |
Reena_60–69_Employed Part-time (pre-lockdown)_IMD 2_lives alone_2 + _shielding_18/05/20 | Now I’m right back to square one again …. You just get forgotten, don’t you? You just feel like you just disappear. That’s how I feel. I’ve just disappeared. I’m not very good at … If she’s not expecting me to call, I don’t know. I don’t know her … I knew the old one. I knew the old one quite well. I don’t know her. I don’t know how it can be, because you can’t really do anything or go anywhere. I think this is just how it’s got to be, in a way …. You’ve just got to put up with it I think, and get on with it … .. at the moment I don’t know what they [intervention] can do really, apart from just talk to me maybe. |