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Social prescribing - transcript

Aileen: Hello, and welcome to the safefood podcast. I'm Dr. Aileen McGloin, Director of Marketing and Communications at safefood, an all-island body promoting food safety and healthy eating.

safefood is one of six north-south bodies born out of the Good Friday Agreement, so developing partnerships across the food and nutrition sector and with government agencies is a big part of our job. In nutrition, our role is to carry out research, develop educational tools, and run public awareness campaigns. You may know us from our Start campaign, Promoting Healthy Weight for Children or our research revealing the real nutritional content of foods like energy drinks and protein snacks. We also run and sponsor conferences and events, so that professionals and thought leaders can share their research and knowledge.

In this nutrition podcast series, we'll be hearing from leading experts on issues such as social prescribing, obesity, particularly in relation to children and food poverty, and community food initiatives. In this episode we are joined by Margaret O'Neill of the Health Service Executive and Tony Doherty of Social Prescribing Network Ireland to explain how social prescribing can change the way we provide healthcare. Thank you both for joining us today.

Margaret: Thanks, Aileen.

Tony: You're welcome.

Aileen: I think I'll start by asking you a question, Tony, just for our listeners, could you explain social prescribing and how it helps patients?

Tony: Yeah, social prescribing is a simple mechanism that is often used more and more nowadays between GPs, their patients, and the communities in which they come from. And what GPs have been saying for a long number of years is they get all sorts of people presenting to them with a whole variety of ailments and issues and so on. And while GPs are good at curing conditions, that's what they're paid to do, that's what they're trained to do, they are also presented with a whole range of social and psycho-social issues that are more to do with the wider determinants of health and not necessarily medical issues, but can be a combination of both.

But what would have happened in the past is that the patient would've come back a few times with their issues and may well end up being medicated because their condition had worsened. Whereas social prescribing is, in a sense, is an upstreaming mechanism for GPs and others to refer patients through social prescriber to things that happen within their community and which they're not part of. So for instance, if you're suffering from loneliness and social isolation, your mental health may not be that good and you're going to your GP, your GP can say well, I think what's going on here is you're not that well-connected to things that are happening in your community, and would you like me to refer you to a social prescriber who may be able to talk to you about what you might want to do with your life.

So it can become a life-changing conversation. And if they agree, the doctor will provide the patient's information to a social prescriber. The social prescriber can be based in the practice or they can be based in the community. Either way, they will have access to a network of community assets and organisations, projects and programs, and they will chat to the patient, probably in their own home, or in a community center, or a cafe, or wherever, and they will help them work out what's, what matters to them as distinct from what's the matter with them.

So trends would say psychology, but from looking at this from a sort of negative perspective as in, what's wrong, to what matters to you, what would you like to do? Then eventually to what the conversation becomes, so the social prescriber will be well aware of what has happened within their community, will be very conversant about the various projects that exist and who would be best suited and who the person would be best suited to link up with. So they could be sent, for instance, to a welcome club or flower arranging or God forbid, line dancing, which already exists in their own community. It's just that they're not part of it and they don't know about it, so the key thing is how best to link them up.

Aileen: Is this something, it seems such a perfect solution. Is this something that healthcare workers, health professionals have been doing anyway without this, the kind of structures that you've, can it be done without these structures? You've got your GP, you've got your link worker, your social prescriber, and then you've got, I suppose, hundreds of community activities that they could refer to. Has it been done in the past and what's needed to make it happen?

Tony: Yeah, it is being done, as we speak, from the point of view of the Social Prescribing Network Ireland, we would like to see it being done more and better and become more widespread and to be more recognised as a bonafide intervention. I think it's moving in that direction, but at the moment it's piecemeal and depending on what part of the country you live in, you might be able to access a social prescribing project or service, but you may not. So it's not widespread. It's moving in that direction. It's becoming more and more popular. A lot of GPs, their suspicions at times have been sort of assuaged and I think more and more medics, more and more mental health workers, more and more people within the health service are beginning to see the full benefit of what community actually is, 'cause social prescribing is really community development with bells on. I've been working with, as a community development manager since the early 1990s, and we always sort of wondered what social prescribing actually was, but really all it is it's creating a mechanism between the general practice or the primary care practice and the community, and creating that link of information and patient flow between the two. And what we've been told and what some of the research proves is that the outcomes for patients are far better. Patients become far healthier from a wellbeing point of view and are more prone to going out and doing other things with their lives, reengaging with activities that help their lives.

Aileen: You mentioned the Social Prescribing Network there, could you just tell me a little bit about how that works and what it does?

Tony: Yeah, well it still, we're still in it's early formative stages, even though we've been going about two years. So it's a group of people north and south of the border, who work together on an all-Ireland basis. There's a number of academics, number of practitioners, community sector representatives, there's general practitioners on it, and the role of that group is to try and influence policy or create policy as much as we possibly can in government, because we don't have a policy, either north or south. There's a policy in Britain, for instance, and the English Health Service has a policy towards social prescribing, as does Scotland. So we feel here that we need a policy, so that the network is in one hand trying to drive policy forward with politicians, but it's also trying to work out how best to create a full network of social prescribing projects throughout the island.

Aileen: I mean the other side of this is that the community initiatives themselves are key. Can you tell me a little bit about some of the successes that you might have seen over the years?

Tony: Social prescribing is community development with bells on. And over the years community development would have basically opened its doors to the walking well, as we describe them. Social prescribing is different in that it takes people who, or receives people who need the services more than want them, more than those that simply want them. So there's a lot of anecdotal success stories and some stories actually that really go to the heart of what social prescribing is. There was a man in Castlederg in County Tyrone in his 70s, who was referred by his GP to the local social prescribing project in that area, and when he started talking to the social prescriber, he actually told her that he used to post himself a letter at Castlederg post office every week so that he would have a conversation with the postman as the postman delivered the letter to him. So for him this was his way of creating his own sort of social life as an older man living alone, his family are all away, and that would be not untypical of what you actually hear when the conversation takes place between the patient and the social prescriber, and that person then was successfully referred on to, I can't remember the actual activity itself, but he was successfully referred on to an activity within his community and is now fully engaged in that.

Aileen: It's an incredible story, I have to say.

Tony: It is.

Aileen: I am going to come to you, Margaret, now, and obviously your main area of work is in nutrition.   And you've been involved in social prescribing, as well. Just before we talk a little bit about that, can you tell me a little bit about why this focus on nutrition is just so important?

Margaret: I suppose for us over the years, trying to improve people's health through food, one of the challenges has always been the hard to reach people. So people who, as Tony said, that need the help, but really for a whole variety of reasons can't, I suppose, can't engage and can't access that help. So, I suppose, for me food nutrition is so important because everybody eats. We know that the impact of sitting around the table with people, that social interaction with people, is so important for people's wellbeing, but for me as a dietitian, it's also good for their nutritional health. So for me it's an ideal way of engaging with people if you can get people sitting around a table, they'll talk not only about what they're eating, but they'll talk about their families, or what they do everyday, or lots of different things, so for me food, that's what food does. It's special, you know, it really brings people together, and people that really need it, we need to try and engage them even more to try and get them included in some of the activities that we have. Aileen: And one of the projects, the healthy eating programs that you worked on is "Healthy Food Made Easy." Just talk about that specifically. How has that helped...

Margaret: Yeah.

Aileen: Communities beyond what you've already mentioned?

Margaret: Yeah, yeah, well Healthy Food Made Easy is a six-week community cooking program. So we started, and I have to say, probably about 20 years ago now, where we identified that within disadvantaged communities there was extra needs required to be able to support people around food and around cooking and around cooking skills. So we developed a program which is based on healthy eating guidelines, the six kind of weeks that we run the program for are based on different messages. But, I suppose, from running the program, we've also identified that a really good way of engaging with people in disadvantaged communities is with peer leaders. So we train up peers, local people who have an interest in becoming a peer leader in the community, within that community-development approach, and they run the program for us. So it's not the HSC or the health professional coming in to tell them what to do or to work with them, it's one of their own people who have experienced the same thing as they have, and that's been shown to be much more beneficial than having people change behaviour. So it works really well. And, I suppose, from running the program, being involved in the program, working with partnership organisations, it's a bit like Tony says, hard to quantify the difference it makes, it's really hard to measure the difference it makes, but when you're sitting in a group of people who may not have engaged before, and they're sharing food, and they're talking, and they're laughing, and having a good time around food, it's really powerful and it's really, it just makes such a difference to people's lives. And that's what social prescribing is for me all around, is all about, is that making a difference to people's lives and improving. The added bonus is we know it improves their mental health and well being, we know it improves their physical health. So lots of benefits for it.

Aileen: What kind of groups would have attended these programs?

Margaret: A whole range of groups from, we run the programs in family resource centers where there are groups of young mothers, young parents, we've run it in a lot of community centers, we run the program, because we work with our partners, with partnership organisations. We've also run it within homeless services. We've run it with, where we've identified maybe some of those harder to reach groups like isolated older men. We did try and train up some peer leaders, older men as peer leaders a number of years ago and it worked quite well. We haven't managed to keep it going, so maybe now we'll reinvigorate that one, with the Social Prescribing Network. So a whole range, addiction services, mental health services. We run it within the HSC, then we train up our own staff to be able to run that, so where we have maybe an OT, an occupational therapist, working mental health who work with groups, we get them to deliver the program as part of their work. So a whole range of programmes.

Aileen: And how, at the moment, are people referred into the programmes?

Margaret: Well, in some areas we have a coordinator based in our partnership, so they're obviously working in the community, they know all the different groups and they can actually, the groups contact them or they reach out to the groups and offer the program to them. So for those pre-formed groups, that's the way it works. We're also running for the Men's Sheds, at the moment, as part of their health programs, so the six-weeks Healthy Food Made Easy program has been delivered as part of that. But we also open it to, in some libraries we run it as a kind of an open where you can self-refer, so people can come and engage in the program. So again, I see that social prescribing could be a way of actually linking people in through the social prescriber into these programmes in a bit more of a structured way, because, again, we may be missing people who really would benefit or really would enjoy these types of programmes as well. So it's trying to maximize getting people in, the right people in, and supporting people to come in the door and engage in the groups.

Tony: And there's a whole series of overlaps and just listening about, you were saying there about about engaging people, we did a region-wide series of chronic pain support groups, so we were encouraging GPs and clinical psychologists with pain to refer patients into the support groups and so we got a whole range of individuals involved and the outcomes from those were astounding. I mean there was one, there was one woman, I'll get to the point in a wee second, but there was one woman from the lower Ardboe in Belfast who was only 50, and she hadn't been out of the house for five years because her pain was so was so great a burden for her so she became detached from her peers and her social circles and so on. And there was another woman in Derry who suffered from fibromyalgia and now she has as a result of her taking part in the first programme she has been trained up to take the second programme which is now starting in September. When we did the programme just finished there in March past, we had asked the patients what else would they like to see as part of any new programme going forward and they said they would like to find out more about the relationship between pain and food which there is, it may not be entirely obvious, and it may not be entirely profound either, but there are a number of issues connected between pain and food intake. For instance, there is the ability to shop, is a big issue for people living with pain. There's weight problems for people who are pre-operative and find difficulty, they're pre-operative for say orthopedic surgery and they're having difficulty keeping their weight down because their pain doesn't allow them to exercise as much as it previously was, so there's a connection between all, so sometimes the overlaps in these things are really, really interesting and they're unexpected.

Margaret: Yes.

Aileen: It's an incredible outcome that the participant became the trainer and as you said it's very difficult to measure some of these things.

Margaret: It is and it's been one of our challenges with Healthy Food Made Easy where we've peer leaders who've run the program for us and then go on and do another course and then go on, and then we lose them as a peer leader because they become back into full-time employment and from our point of view.

Tony: But that's an accomplishment.

Margaret: That's a huge accomplishment. We've one of our coordinators who's gone on to become a psychotherapist because she loved helping people so much she went back to college, kept up her role as a coordinator, and now is using her information she knows about food to help people still throughout her work. Because of all those issues that you've talked about, those links between your mental health and wellbeing and how you eat, so not what you eat, but how you eat, so it's all intertwined. It's really interesting.

Aileen: And you mentioned, when you spoke earlier, Margaret, that you'd seen food as a real connector of people through your food programme that you had carried out with the young Mums. Could you tell us about that?

Margaret: Well, we'd recognised again particularly in some of the low income areas where some of the public health nurses had told us that they were having challenges around young mothers maybe starting their babies on solids too early. We looked at ways that we could actually develop a program around that. So we adapted a weaning program called, "Baby Food Made Easy." We had been working with public health nurses and primary care in the area. They had actually told us that they were finding it difficult to engage with young mothers in the area around weaning and putting, starting the baby on solids. So the mothers were starting on solids too early which again isn't something that we wanted, so we adapted a weaning program. So we developed Baby Food Made Easy, so it's a two-hour programme that the public health nurse recruits or refers people in from when they see them at the baby checks in primary care and they are invited to come to a community center, it might be in the health center, where they attend a two-hour session on weaning, but also we show them how to cook purees and how to cook the different food they need for their baby. So again it is around budgeting, it's around getting good nutrition in, but also has created a whole support network for those young mothers who could be quite isolated in communities, young mothers often are, and so it has worked really well, and then it also links the public health nurse into those mothers again then for any problems that they have in the future. So again a really good outcome. It was a really good way of engaging with young mothers and getting good nutrition across and facts about good nutrition and support.

Aileen: So just to wrap up, what's next for social prescribing on the island of Ireland?

Tony: I think we need a policy, both north and south of the border, and I would be very, very hopeful that we will have a policy that applies to both parts of the island, but which also conjoins them in different ways. And I think that policy should recognise the role of the health service, the role of the community sector, and the role of other sectors, including the wider public sector in this, as well. So I would be very optimistic that that will happen. I think there is a sense that there's a growing movement throughout the island around social prescribing, which I think is a fantastic sign and that will lead on to much greater benefit in the years to come.

Margaret: I suppose what I'd like to add to it is that I think social prescribing as a concept isn't known, even though a lot of us have been doing it for years, and I think that's what, there's a PR campaign to make people understand what it is. I think absolutely right the framework, the policies need to be there. In terms of HSC we have self-management support coordinators who are doing that mapping of community services that are there. A lot of this is around making people aware of what's there in the first place, but also then the key is that connection. That won't help anybody if that person isn't supported and connected into it, so I think while we have a lot of the information there, we have a huge amount now under Healthy Ireland, we have a huge array of supports available to people, but the missing link is, it's a bit like the lunchbox is no good to you, a healthy lunchbox is no good for a kid if they don't eat it, it's a bit like this, we can have all these programmes and initiatives that we like, but if the people who need it most aren't enabled to get in the door and get that support. So I think it's a bit of joining up the dots for me. Making people aware what social prescribing is but also making us all aware of what it is and how we can work together to build social prescribing into what we do.

Aileen: I think we'll end on that very positive note. It sounds like a great time for social prescribing to grow and develop on the island.

That's all from this episode in our nutrition series. Thanks to my guests Tony Doherty of the Social Prescribing Network and Margaret O'Neill of the Health Service Executive for sharing their poignant stories and experiences.

If you would like further information on social prescribing or any aspect of community work, do get in touch with us. Search safefood or look us up on social media. You'll know us by our purple tick. You can link in with our food poverty network and All-Ireland Obesity Action Forum. Or to keep up with our latest reports and research check out LinkedIn. And remember follow the safefood podcast series on iTunes, Spotify, or wherever you get your podcasts.

Until the next time then, goodbye.


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