A couple of weeks ago I attended the first ever National Social Prescribing Network Research Conference at the University of Salford. Currently engaged in attempting to understand the nature of social prescribing across Greater Manchester, I found the conference both informative and inspirational.
I didn’t expect to be struck with a need to speak out about the obvious link (well it’s obvious to me…) between social prescribing and another of my ‘social’ interests – social accounting.
Social prescribing is a means of enabling GPs, nurses and other healthcare professionals to refer people to a range of local, non-clinical services. This approach is gaining momentum as an alternative to clinical care and prescribed medicines.
The influential charity, the Kings Fund describes how,
‘Recognising that people’s health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health.’
At the Social Prescribing Research Conference, Chris Dayson from the Centre for Regional Economic and Social Research at Sheffield Hallam University spoke eloquently about approaches to evaluation research. He then produced a slide which called for the ‘emancipation from the need to prove’ – to cheers and applause from the audience.
Chris explained that there is a need to focus on robustly gathered evidence, using this in policy and practice, over proving whether something is true (or not).
This got me thinking – why do commissioners and funders of social prescribing services expect a provider to ‘prove’ the full extent of all the outcomes (and often longer-term impacts) felt by every single service user? This can be difficult to do, costly, and inconvenience to both provider and service user, and may create a whole ‘industry’ of inappropriate data collection and analysis.
The need to prove everything is often challenged as being unreasonable for the majority of small, voluntary, community or social sector ‘providers’ that the social prescriber is hoping that their patients might reach. Many are community or voluntary groups, some are small social enterprises, and most are not geared up to meet commissioners’ demands for intensive monitoring.
I acknowledge that there is a growing body of professional research, and emerging online systems for data capture in social prescribing, but questions still remain for service delivery; how long should a person be ‘tracked’ to prove a health outcome, and should every single service user be tracked? As Chris Dayson has said – we should have robust and meaningful collection of data and research to inform future delivery, rather than attempting to prove absolute (or statistically absolute) truth.
We must also see this from the funders and commissioners point of view. They want to know whether the social prescribing has been successful – to justify their investment in these times of austerity and that people aren’t just going to come back to their GP when they have tried out their ‘social prescription’?
Given the current budget constraints for funders and commissioners, there is also value for money issues to consider. I believe that the health ‘system’ is interested in social prescribing to the Voluntary, Community and Social Enterprise (VCSE) sector because of the potential medium to long-term savings that they believe will accrue.
What we need is for funders and commissioners to feel better able to trust the services. This used to be the case but was abandoned in the 1980s and 1990s when the world took a neo-liberal turn. What if a methodology exists whereby VCSE organisations could prove the outcomes that they create, be able to use this information to improve what they do, AND be accountable for the outcomes and impacts that their work is responsible for?
What if this were part of their normal way of doing business, used in reporting back to commissioners, funders and to others, thereby building their trust and understanding of how the outcomes are actually achieved? Could this then allow the people holding the purse strings to relax their stranglehold on senseless data collection and reporting?
The thing is, a methodology DOES exist, and it was developed over many years within the VCSE sector, building from practice and experience from across the UK and beyond.
This is where social accounting (and audit) fits in.
Social Accounting and Audit allows an organisation to build on existing monitoring, documentation and reporting systems to develop a process to account fully for social, environmental and economic impacts, report on performance and draw up action plans to improve on that performance. Through this process, an organisation can collect and report robustly on the outcomes and impacts that its activities create.
VCSE organisations like the Neuromuscular Centre in Cheshire have been using it to great effect for many years. Others like Inspiring Communities Together in Salford have adapted the methodology to embed effective, community-driven outcomes reporting.
The Social Audit Network (SAN) exists to promote, support and facilitate the practice of social accounting and audit. It is a grass-roots movement which holds regular events across the country and deserves a greater profile within the VCSE sector and with commissioners and funders.
But this is the issue… in order to truly ‘emancipate’ VCSE organisations and break the shackles from the need to prove, small and medium-sized voluntary groups and community-based organisations which provide the services and activities that are vital for social prescribing need to know about, and adopt social accounting into their organisations…
Social accounting can bring so much more than just evidence to prove to funders. SAN has always thought that being able to prove organisational outcomes is important – BUT mainly for the organisation itself. Social Accounting allows an organisation to use the data and research findings to inform future practice and improve performance. Publishing this information makes an organisation more accountable to its stakeholders, which in these times of challenges to transparency has become extremely important.
For me, true emancipation only comes when the VCSE organisations are in control and not their commissioners and funders…
Finally, we should acknowledge that time and longitudinal studies are important – which is why SAN suggests regular social accounting. The process should be embedded into organisational practice and reported on consistently over time.
All this presents a challenge to SAN and to the funders, commissioners and decision-makers in the health system. If the funders and commissioners truly want social prescribing to work, they should invest in the VCSE sector, its infrastructure and capabilities, in order to make those longer-term savings that they so desperately seek.