The Rt Hon Steve Barclay, Secretary of State for Health and Social Care make Social Prescribing Link Worker services a priority to sustain the NHS

Dear Secretary of State for Health and Social Care

Growing crisis requires creative disruption: urgent action is required to demedicalise healthcare where alternative action is more appropriate.

We are writing on behalf of our members at the National Association of Link Workers (NALW) to
congratulate you on your reappointed role as Secretary of State. Your appointment comes at a critical
moment in efforts to transform healthcare for all. While we understand you will have much to do,
investing in social prescribing to reduce costs to the NHS and ultimately improve patient outcomes must
be a priority.


Following the publication of the NHS Long Term Plan (LTP), the NHS has begun a decade-long journey
towards an integrated health and care system focused on prevention and population health. We are
pleased with the role social prescribing link workers (SPLWs) have played in ensuring the NHS LTP
target of 2.5 million people benefitting from personalised care has been met [1]. Now that it has been two
years on, we must focus on the newer targets set by the previous Health Secretary to ensure 4 million
people benefit from personalised care by March 2024, including access to social prescribing. Your
department must follow through with this commitment to urgently reform and demedicalise the NHS,
where non-medicinal use is more appropriate[2].


However, with the current pressures on systems, medicinal use is increasing, which moves away from
prevention and puts great financial pressure on the NHS. An estimated 83.4 million antidepressant drug
items were prescribed in 2021/22, a 5.07% increase from 2020/21[3]. Social Prescribing Link Worker
services are the appropriate response to non-medical determinants of mental health.


Furthermore, pressures on emergency or services can be reduced through social prescribing. For
example, H4All social prescribing link worker service supported an individual who struggled with repeat
intentional foreign body ingestion, self-harm, and suicidal ideation. Before the link worker intervention,
this individual had 57 A&E admissions. After 2 years of the social prescribing link worker building trust
and providing personalised care the patient showed a significant reduction in A&E attendances and nonelective admissions, which resulted in a total savings of £555,696 to the NHS, £3 return on investment
for every £1 [4]. This further evidences the health and economic impact of social prescribing link worker
services.

Furthermore, the cost of living crisis has further exacerbated pre-existing pressures on the system and is
another reminder that our environment shapes our health. The Inequalities in Health Alliance (IHA),
convened by the Royal College of Physicians (RCP), published the results of polling commissioned from
YouGov showing that more than half of British people (55%) feel their health has been negatively
affected by the rising cost of living [5] . We support NHS England’s plans to increase capacity and
resilience ahead of winter[6]. Still, we urge you, Secretary of State for Health and Social Care, to go even
further by providing better support for people within the community. Community health through social
prescribing is essential to sustaining the NHS, and social prescribing must be respected as an
independent care model, not damage control or an optional addition.


To prevent ill health and health inequalities, action must be taken on the wider determinants of health,
such as poor housing, lack of educational opportunities, communities, employment, racism, and
discrimination. In addition, the cost of living crisis has worsened experiences of health inequalities.
Without a cross-government focus on all those issues, the Department of Health and Social Care and
NHS will be left with the burden of fixing a broken system caused by people’s environments. The system
is failing the people who rely on it, with high levels of unmet needs and providers struggling to deliver the
quality of care that vulnerable people have a right to expect. These combine to place tremendous
pressure on families and carers. As the current system struggles to manage, the financial and human
costs are mounting.


Significant reform will take time. In the interim, owing to the growing crisis, increased use of
antidepressants, the impact of the cost of the living crisis on health, NHS elective care backlog, and
worsening inequalities, your department must decisively increase commitment to social prescribing link
workers. We must all recognise the value of social prescribing as a vital service in its own right, which
prevents ill health, and supports people to live well and independently, rather than as a pressure valve
for the NHS.

Our research with Patient Participation Groups found that SPLWs are highly valued for
patient care.[7]. The consequences of not recruiting sufficient SPLWs will have even more detrimental
effects on the NHS and the wider system. Given the current challenges the NHS faces, this should not
be a risk we are willing to take. It’s time to live up to the promise of the NHS constitution and deliver a
national health service that treats the whole person rather than patch up and medicalising social
determinants of health, one that is radical and works well for all.


Social prescribing will not realise its potential unless we have the right structures and systems to support
it. To be effective, social prescribing link workers must be widely embedded across health and social
care– contributing to and drawing on the work of the NHS and broader. There is a significant opportunity
to achieve the Government’s commitment to narrow the 20-year gap in healthy life expectancy by 2030
by committing to delivering a cross-Government strategy for social prescribing. Without your
department’s bold and necessary action, health care reform will be impossible.


Call to action: make social prescribing link worker services a priority in sustaining the NHS. Prevention
is better than cure! We have to reduce demand on clinical services and support people live
independently in their community and not encourage them to medicalise their social issues or shut our
doors when they arrive at NHS’s door- it won’t make them stop coming!
Social prescribing link worker model is a cost-effective solution and provides tangible benefits to the
current economic crisis; we are willing to work together with you to put the health service back on a firm
footing.

[1] NHS Long Term Plan » 3. People will get more control over their own health and more personalised
care when they need it
[2] Health and Social Care Secretary speech on Health Reform – GOV.UK (www.gov.uk)
[3] https://www.nhsbsa.nhs.uk/statistical-collections/medicines-used-mental-health-england/medicinesused-mental-health-england-201516-202122
[4] https://www.nalw.org.uk/wp-content/uploads/2022/10/A-Guide-to-Social-Prescribing-Link-Workers.pdf
[5] https://www.rcplondon.ac.uk/news/over-half-brits-say-their-health-has-worsened-due-rising-costliving
[6] B1929_Next-steps-in-increasing-capacity-and-operational-resilience-in-urgent-and-emergency-careahead-of-winter.pdf (England.NHS.UK)
[7] The-Role-of-PPGs-in-Social-Prescribing.pdf (nalw.org.uk)

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How Social Prescribing Link Workers are reducing social inequalities in the response to Covid-19

The NALW showcases the role of SPLW and its importance in reducing social inequality, facilitating access to care, and reducing pressure on NHS services. SPLWs are essential for any COVID-19 recovery plan, particularly as Covid has massively affected marginalised communities. If social inequalities are to be redressed then more SPLWs need to be trained, recruited, and utilised in the fight against inequality. SPLWs provide social, emotional, and practical solutions which ensure that social inequality is minimised.

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