Our Connections Cymru network met recently to learn how social prescribing can benefit people with a learning disability. The event featured a packed agenda with examples and views about social prescribing from across Wales.
The aim of Connections Cymru is to work together to tackle loneliness and social isolation for people with a learning disability. On 29 March 2023 we brought over 40 people together to look at the various opportunities that people with a learning disability can get from social prescribing, and what we can do to overcome the barriers that are preventing people from accessing it.
What is social prescribing?
Social prescribing is an individualised approach that connects people to activities, groups and services in their community to meet the practical, social and emotional needs that affect their health and well-being. Although it has been around for quite a while and is active in some areas, there is a perception that it can only be accessed via a GP and that it is mainly to help people with mental health needs.
There are different models for social prescribing, but most involve a link worker or ‘community navigator’ who works with people to access local sources of support. Some of these are based in the third sector, employed by county voluntary councils.
Welsh Government Framework
Dr Ruth Northway, from University of South Wales (USW), was our first speaker, and began by talking about the Learning Disability Ministerial Advisory Group’s contribution to Welsh Government’s All-Wales national framework for social prescribing. There is a video on the Welsh Government website that gives a useful introduction to social prescribing and the proposed framework. The consultation period took place between July and October 2022 and the final document is due to be published this summer. Learning Disability Wales submitted a response to the consultation (PDF).
Are people with a learning disability accessing social prescribing?
Dr Northway went on to say that there is limited evidence about the use of social prescribing by people with learning disabilities. The reasons for this may be that people are accessing services and support that are not necessarily labelled as social prescribing or people may not be identified or self-identify as having a learning disability. Dr Simon Newstead of USW is producing a glossary of terms used in social prescribing and an easy read version is also being produced.
The situation in North Wales
Mark John-Williams, from North Wales Together, shared information gathered last year about social prescribing in North Wales. Mark reported that the service is varied across the regions with different names and approaches, whilst not all the services are accessible or available for people with a learning disability. There is also not enough support to access groups or activities.
Mark talked about poor transport and lack of changing places in North Wales, and the need of more joined-up working between the connector service and the learning disability services and community. The service needs to be available to all, and not based on labels, whilst information and language needs to be accessible.
Mark stated that social prescribing needs to be more than just a signposting service and there may need to be additional support to access groups or activities. Good practice examples featuring people with a learning disability should be shared, and work needs to be done on a community development approach where people go from ‘being present’ to ‘contributing’ in their communities.
Lastly, Mark raised a crucial proposal that people with a learning disability could themselves be working or volunteering in community connector or buddy roles.
Bridgend Community Navigation
Gail Devine, Community Navigator at Bridgend Association of Voluntary Organisations, explained how social prescribing worked in Bridgend. They employ 8 community navigators. One of the people who benefit is Melanie, who joined Gig Buddies Cymru and now has a Gig Buddy to go out and socialise with, as well as making new friends and being part of the wider Gig Buddies community.
We also heard from Grow Well, a gardening project in Cardiff where referrals come from health and social care. They offer a range of activities but don’t necessarily promote it as ‘gardening’ because it is more about having a cup of tea and sitting down with others to chat and enjoy the gardens.
People are referred to the project for several reasons including social isolation, loss of role after retirement, anxiety and depression, bereavement, caring responsibilities, living with chronic health conditions, stress, low confidence and self-esteem, lacking a family/social network or recovering from a health condition. People with a learning disability are part of the project but don’t necessarily identify with a ‘label’.
People attending the meeting had a chance to go into groups to discuss the benefits, barriers and what more can be done to increase access to social prescribing for people with a learning disability.
What are the benefits of social prescribing for people with a learning disability?
An introduction to 1 group or activity can be like a ‘stone in a pond’ as it can ripple out to other opportunities. People don’t always have the capacity to do self-research about the activities available in there are so social prescribing can help with this. Other benefits include:
- Reduced social isolation and loneliness
- Improved mental health
- Can lead to a more fulfilled life
- An organic way of making friends and support networks, and to having a social life
- Increased confidence and help developing new skills
- Social prescribing is person-centred
- Gives people a sense of belonging, contribution and purpose
- Having non-paid people in a person’s life is important.
Gig Buddies is a good example of how social prescribing can help reduce loneliness and social isolation. Members of All Wales People First have developed new friendships, have gained confidence and skills, and gained a great social life.
What are the barriers?
- The referral process is not known for some, or it varies a lot in each region.
- It is difficult to work out how many people with a learning disability are supported in this way as they might be accessing without ‘social prescribing’.
- Organisational barriers are linked to risk-averse attitudes.
- Do GPs have the time, awareness and understanding? We already know about the issues with annual health checks so will they have time to do social prescribing?
- Charities who run groups or activities are often under-resourced and rely on fundraising.
Transport was identified as a potentially significant barrier. To access mainstream community activities people need good transport but this is often difficult. Public transport can be patchy, especially in rural areas, and often doesn’t run late in the evenings. In Bridgend, community transport is only available between 10am and 2pm so this restricts what people can attend. There have also been problems with getting bus passes as the eligibility criteria seem to have changed recently without explanation.
Lack of accessible information and communication issues are also barriers. When people aren’t listened to, it can take a while for them to be open and talk about what they want to do or what skills they have so this needs to be part of the process. Sometimes the process isn’t effective for people, and it doesn’t reach the right people and places. Some people with a learning disability know what social prescribing is but don’t always recognise that was what they were already accessing. There needs to be more accessible information (eg easy read) available for people. Could there be a database of activities that people can access?
Not all social activities are free, and this can make it difficult for people to take part. For example, if a GP prescribes going to the gym, then that comes with a cost. People need to be able to access more free community activities.
Lack of suitable support can also be a barrier. Some people need support to go to activities or to travel and not everyone has that support when they need it. However, community navigators can help people with the first few visits to a new group so they can get used to it.
Working together, what can we do to help more people with a learning disability access social prescribing?
We need more community transport. We all need to be working with transport partners such as Community Transport Association. Mark John-Williams is working with Community Transport Association in North Wales and partners to try to get more diversity in community transport.
We need to network with other organisations. We need to do more community mapping to see what is out there and then work together.
The group heard that more accessible information on social prescribing is needed, for example in easy read, whilst we need to get the message out to multi-disciplinary teams so people can be referred to and access social prescribing.
It was recommended that the third sector should work more with partners in health and education. We also need to be working more with GPs/primary care, while social prescribing should be added to the annual health check. GPs need to see the benefits of social prescribing for people with a learning disability as a possible alternative to medication in some cases, for example if someone is depressed due to loneliness or social isolation.
The group could see the potential of the community navigator role, employed in the third sector, in supporting people to go to events.
People felt that the DEWIS database needs to be easier to use and we all need to be using the same ‘language’ and terms.
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