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How to make social prescribing effective for older people experiencing financial hardship

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Social determinants – the conditions in which we live and age – have a real impact on physical and mental health, including health inequalities. For many people aged 65 and over, financial hardship and poverty contribute significantly to poorer physical and mental health.

A report published in 2023 by the charity Independent Age on the impact of increasing household costs on older people’s quality of life showed that two million older people in the UK are experiencing financial hardship and poverty and up to three million have precarious finances. These older people face difficult decisions when it comes to managing limited financial resources, which can then lead to poorer mental and physical health due to inadequate nutrition, poor quality housing and increased social isolation. These, in turn, can exacerbate existing health conditions and contribute to declining physical and mental wellbeing. Additional characteristics – such as disability, ethnicity and gender – can further compound older people’s experiences.

What can social prescribing offer older people who are seldom engaged by services?

The rising cost of living has seen more older people reaching out for support to local social prescribing services. NHS primary care data shows that an increasing number of older people are seeking support from health care services for issues related to finance, housing and employment – all social determinants of health. However, older people from underserved communities, including the socially isolated and those with English as a second language, tend not to take advantage of the community services available to them.

In light of some of these challenges, in 2023, the National Academy for Social Prescribing (NASP), in partnership with Independent Age, commissioned a pilot programme to firstly, understand how social prescribing can engage meaningfully with older people, experiencing financial hardship including those from minoritised communities who are not currently accessing social prescribing services. Secondly, they wanted to better understand how social prescribing can help to address their needs. The six-month pilot project was delivered through two partnerships in Leicester and Hastings. Both pilots worked in partnership with local health care providers, community groups and voluntary and community organisations.

Although the pilot projects observed the benefits of social prescribing for older people in some areas, the project teams experienced challenges working with some health and care services and engaging with communities. One of the biggest challenges that pilot leads experienced was the lack of cohesive population data on - who and where the older people in need were.

In order to identify areas to focus on, they took time to collate available demographic data on population and needs of the targeted groups. This was followed up with a mapping of local community resources and groups and identifying informal social prescribing services that existed in the pilot areas. Engagement with local community groups and informal networks is invaluable in building on what is already available in the community.

In some areas, identifying and engaging with social prescribing services was difficult, as services were fragmented because of the different social prescribing models and commissioning approaches. The fragmentation of social prescribing services also made it difficult for the pilot projects to build an area-wide picture of services, identify gaps in services and work towards addressing them.

The different models and commissioning practices meant that services were delivered and accessed differently, making it difficult for older people to understand the services and how to access them. More importantly, people did not understand the role of link workers and how they work with local health services.

In order for older people to benefit from social prescribing services, they first need to be aware of what social prescribing is and how they can access it - either through self-referral or through their GP. They then need to understand the role of link workers in supporting them through the process.

What can health care system do to support effective delivery of social prescribing for older people?

Integrated care systems (ICSs) have a role to play in ensuring that community led organisations – assets to communities are sustainable, not just in relation to funding but also by sharing good examples of place-based practice. They can encourage partnership working and collaboration through innovative commissioning models, such as shared investment funds or voluntary, community and social enterprise health and wellbeing alliances, to ensure that neighbourhood-level support and expertise are available to older people facing financial hardship.

Primary care networks can work with wider health services to embed proactive social prescribing within population health management by identifying older people who might be most at risk of financial hardship or health inequalities and offering preventive community support.

Addressing financial hardship and supporting financial wellbeing need to be seen as core elements of health and wellbeing across the life course. Social prescribing has the potential to improve and sustain the health and wellbeing of older people and deliver benefits to health care systems.

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