Tag Archives: health and wellbeing

Housing wealth matters

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With the widening gap between the richest and poorest across different measures of inequality, there is growing awareness that income is not the only factor that impacts living standards. This has led to increasing interest in the distribution of wealth. While wealth can take various forms, the most visible way households accrue and store substantial amounts of wealth is through property ownership.

Property wealth in Scotland has increased ten-fold over the last 50 years – driven primarily by rising house prices, but also by the increasing number of properties and transfer of public housing into the private sector. However, this wealth is not distributed equally. In its recent examination of the scale and distribution of housing wealth in Scotland over time, the Resolution Foundation highlighted the marked rise in housing wealth inequality over the last decade, which is now twice as high as income inequality.

Why?

The new report shows that the growing inequality in housing wealth is in large part due to the fact that while very few families in Scotland currently have no form of income, over one in three Scottish households hold no property wealth at all and those in the top income decile own around 30% of the country’s property wealth.

Additional property ownership has also increased in recent years, adding to the level of inequality. The biggest wealth gaps were found to be in Scotland’s largest cities – Aberdeen, Dundee, Edinburgh and Glasgow – where low rates of home ownership are coupled with ownership of multiple properties, concentrating housing wealth in fewer households’ hands.

In addition, the last decade has seen many people struggle to get a foot on the housing ladder and today’s young people hold less housing wealth than their predecessors. Location was also found to have an impact as house prices can differ greatly by local authority, although these variations have reduced in recent years.

As a result, levels of housing wealth inequality are now nearing the same levels as those in England and Wales, although rates of homeownership remain higher in Scotland than elsewhere in the UK.

With more people now having some form of income than ever before, it is perhaps reasonable to ask why housing wealth is so important.

The Foundation’s report highlights that owning property has value over and above general wealth effects in that it can also provide a secure home; a source of income; and greater financial security in later life. Indeed, the UK Collaborative Centre for Housing Evidence (CaCHE) and Policy Scotland’s evidence review, which complemented the Foundation’s analysis, also highlights why housing wealth matters, citing many economic, health and social impacts.

Why housing wealth matters

While it has been previously argued that housing wealth inequalities are of little significance in terms of macroeconomic impact and can therefore be disregarded, there is now a growing body of evidence suggesting that in fact these inequalities do matter. The evidence review notes that:

  • housing assets are of growing importance encouraging household spending and were implicated in the global financial crisis;
  • access to home ownership is increasingly reliant on parental property wealth with negative implications for social mobility;
  • housing wealth is cumulative: e.g. buy-to-let has increased dramatically in Scotland over the last 20 years, often facilitated by the re-mortgaging of existing property by owners;
  • rising house price and wealth effects reduces productivity growth; and
  • different rates of house price change create inequalities across UK regions.

This is not only the case in Scotland and across the UK; across Europe housing wealth inequality has been shown to exacerbate socio-economic differences by segregating households based on income levels.

In relation to health and wellbeing, housing wealth can be a double-edged sword. A rise in house prices can lead to increased physical health of owners but decreased physical and mental health of renters.

Of course, historically, housing wealth has been seen to contribute to reduced wealth inequalities due to increased home ownership, however, there is now also an emerging concern that high house prices and rents may impair labour supply and productivity.

HWI

Main elements of wealth inequality processes within the housing system (CaCHE, 2019)

It is clear that income is not the only important factor in inequalities. This is illustrated by recent figures on child poverty and in-work poverty, which show that despite recent record levels of employment, two thirds of children living in poverty come from working households and more than half the people living in relative poverty in 2017/18 (53%) lived in households where at least one adult was in paid employment.

The Resolution Foundation notes that while the scale and distribution of housing wealth has changed dramatically over the past 50 years, wealth taxation has not.

Indeed, it has been recently argued that policy is widening the housing wealth divide and that the local supply of housing needs to be realigned with local housing demand if this is to be rectified.

Way forward

The research suggests that a number of actions could be taken to address the growing housing wealth inequalities in Scotland:

  • Firstly, support for sustainable home ownership, especially for those on lower incomes or in the younger age bracket is highlighted as one obvious response, although it notes that policies such as Help to Buy risk stimulating demand to the point that house prices are driven up. As a result, it is suggested that policy action to lessen the demand for holding additional properties would be a more sensible strategy.
  • Second, it is argued that there is a strong case for substantial reform in the area of the property taxation to address the current mismatch between the value of housing wealth and taxation.
  • Third, it is suggested that the Scottish Government could give consideration as to how the benefits of holding housing wealth can be provided to those who are unlikely to ever be able to support home ownership, with more efficient taxing of housing wealth. In addition, the government could also build on their recent reforms which have provided tenants with greater security of tenure and more predictable rent increases, and look to provide more support to low-income families via further supplements to benefits.

With the current system of council tax described as “highly regressive”, “inequitable” and “inefficient”, the research calls for much needed reform.

Both reports acknowledge that radical change is a political challenge but while the Resolution Foundation’s report states the case for action is clear, the evidence review advises caution, suggesting that a more equal housing system is a long-term aspiration rather than something practical and realisable in the short to medium term.

If you enjoyed reading this, you may also be interested in some of our previous posts on housing topics.

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Beneath the headlines: record high employment rate, but what’s more important – quantity or quality?

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Competition for new jobs

The UK employment rate has hit a joint record high of 76.1%, according to the latest official figures. The unemployment rate was estimated at 3.8%; it has not been lower since 1974. The economic inactivity rate was also close to a record low.

It’s not surprising that such record figures are often highlighted as ‘good news’ headlines. However, there has also been an increasing focus on quality of work over the past decade and the impact this has on people’s lives – reflecting concerns regarding developments in working practices, as highlighted by a recent City-REDI briefing paper. It has therefore been argued that the record employment rates are not necessarily representative of a ‘good news’ story.

Concerns

Concerns over working practices include the rise of the gig economy, unequal gains from flexible working, job insecurity and wage stagnation, to name but a few. The City-REDI paper outlines a number of ongoing concerns related to:

  • weak productivity growth;
  • employment insecurity and precarity;
  • in-work poverty;
  • skills shortages and skills polarisation; and
  • the impact of automation, technological change and the gig economy on the nature and experience of work.

Indeed, analysis has shown that much of the recent rise in employment is due to a ‘surge in low-value work’, which is holding back productivity growth. Many people are stuck in low paid insecure work, all of whom are contributing to the high employment rate.

Recent research from the Joseph Rowntree Foundation has reported that four million workers live in poverty, a rise of over half a million over five years – meaning in-work poverty has been rising even faster than employment. The causes of this increase include poorly paid jobs – particularly under temporary and part-time contracts – and a lack of progression routes for people in low-skilled work.

In addition, the rising gig economy shows no signs of slowing down, more than doubling in size over the past three years and now accounting for 4.7 million workers, according to a new report. An interesting finding of the report is that the majority of gig economy workers use this platform to supplement other forms of income, suggesting that workers are not getting enough of an income from their primary employment.

It has also been shown that advances in technology have pushed some workers into poorer quality jobs than those lost, something which cannot be addressed without some kind of policy intervention.

Health impact

Not only is poor quality work bad for the economy, it is also bad for people’s health.

A recent report which examined the impact on social inequalities of policy initiatives and reforms to extend working lives in five European countries, highlighted that working conditions are also known to influence post-retirement health, and for those with lower socioeconomic status, workplace arrangements may be causing or contributing to poor health.

A number of studies have highlighted the link between good work and health and wellbeing. As stated by a What Works for Wellbeing briefing paper, “Being in a job is good for wellbeing. Being in a ‘high quality’ job is even better for us.” It has also even been suggested that being in a poor quality job is actually worse for health and wellbeing than remaining unemployed.

Moves towards improving quality

Recent developments in the UK to address such challenges for the future and quality of work include:

  • the establishment of The Work Foundation’s Commission on Good Work in 2016, which aims to better understand the factors shaping change, and the nature and scale of opportunities and risks, so as to promote policies to achieve ‘good work’;
  • The commissioning and publication of the independent Taylor Review of Modern Working Practices in 2017 which called for policy to address the wider issue of creating quality jobs for all; and
  • the Government’s Good Work Plan, published in December 2018, which sets out the reforms planned to help improve quality of work – the first time the UK Government placed equal emphasis on the quality and quantity of work.

In addition, the Chartered Institute of Personnel and Development (CIPD) launched the UK Working Lives survey, the first robust measurement of job quality in the UK. This has since contributed to government thinking and recommendations around ‘good work’ in response to the Taylor Review.

Despite the widespread agreement over the need to adopt ‘good work’ principles, however, there remains no agreed set of indicators of exactly what it encompasses nor metrics for measuring progress towards it.

What is good work?

As the City-REDI briefing paper and other studies indicate, defining good quality work is complex as quality means different things to different people.

A range of factors contribute to different people’s perception of quality and fulfilling work, including pay, flexibility, security, health and wellbeing, nature of work and job design. The CIPD survey highlights seven dimensions of job quality:

  • pay and benefits
  • employment contacts
  • job design and nature of work
  • work-life balance
  • work relationships
  • voice and representation
  • health and wellbeing

Of course, there is no one size fits all solution.

Final thoughts

While productivity and employment rates undoubtedly remain important, they alone are clearly not enough to understand the health of the labour market; the quality of work also needs to be considered.

As shown by the visible shift from quantity to quality of work in recent years and the recent developments from the government and others, ‘good work’ is undeniably on the policy agenda. However, as the City-REDI paper suggests, there should be a focus on promoting ‘good work’ amongst the most disadvantaged groups such as the young, people with disabilities and those working in hotels and restaurants. It is also suggested that there is scope for further research on good practice in promoting ‘good work’ in establishments of different sizes and in different sectors.

As highlighted in the Taylor Review, “All work should be fair and decent with realistic scope for development and fulfilment.”

You may also be interested in some of our previous employment-related posts:

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“For many children we are the first point of contact”: supporting children’s mental health in schools

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A 2018 evidence review from Public Health England reported that one in 10 young people have some form of diagnosable mental health condition. This, the report suggests, equates to as many as 850,000 children and young people with a diagnosable mental health disorder in the UK. It also reported that half of all mental health problems emerge before the age of 14, and children with persistent mental health problems face unequal chances in life.

Research has also highlighted the impact of “key factors” like poverty and adverse childhood experiences (ACEs), including emotional trauma, abuse or neglect (which people living in higher areas of deprivation are more likely to experience) on an individual’s chance of developing a mental illness. However, an additional factor often cited in surveys around child mental health and wellbeing is the impact of school, including exam stress, and bullying. Mental ill health has also been found to have an impact on attainment, behaviour and a child’s ability to learn. As a result, teachers are often part of the front line of supporting adults for children who are suffering from mental ill health, with increasing pressure being placed on teachers and schools to identify and signpost children to other services.

Schools, as well as teachers,  are increasingly becoming a focus for the delivery of Child and Adolescent Mental Health Services (CAMHS) in their community. Often schools are at the centre of their local community, so it is logistically convenient to coordinate services there; it can for some be a less intimidating or stigmatising environment than attending a clinic at a GP surgery, for example. School is the primary developmental space that children encounter after their family, and children’s learning and development and their mental health are often interrelated, so it makes sense for teachers to take an interest in terms of attainment and progress in learning. In December 2017, the Department of Health and Department for Education (DfE) published the Green Paper Transforming children and young people’s mental health provision which highlighted the role of schools as key in promoting a positive message about mental health and wellbeing among school age children and young people.

Good work is already being done, but how can we do more?

Research has shown that there is already a lot of good and effective practice being done in schools around children’s mental health. Many schools already work in partnership with local health teams to provide in house CAMHS support in the form of mental health nurses and social workers who are posted on site for children to access. One of the major recommendations in a 2018 Audit Scotland report on child mental health in Scotland was to encourage more of this type of partnership working. The report stressed the importance of joint working between public services if child mental health is to be improved, and where possible to include as wide a spectrum of public services in the delivery of CAMHS support, including criminal justice and housing practitioners, as well as health and social care and education staff.

In some schools senior pupils and designated members of staff are being offered mental health first aid training, and wear lanyards to help students identify them should they ever need to talk to someone. While it is important – particularly for students who participate in mental health first aid programmes – to be made aware of the challenges the role may entail, it can be a rewarding experience for young people to participate in and can also be a vital in-road to support for some students who would otherwise feel uncomfortable talking to a member of staff.

Other programmes like those developed by the Anna Freud National Centre for Children and Families, Centre for Mental Health and the ICE PACK and Kitbag tools (which have been used widely in UK schools) look at resilience building  and promoting coping mechanisms among young people, as well as encouraging the creation of trusting relationships which focus on nurturing and normalising mental illness to encourage children and young people to feel comfortable discussing their feelings and thoughts. These programmes also integrate early intervention and prevention approaches, hoping to identify children and young people who are suffering from mental illness as early as possible and signpost them to appropriate support.

The specific role of teachers

Teachers need to remember that they are not health or social care professionals and that – as much as they would like to completely solve all of the problems of their students – they can only do what they can, and that is enough.

It is also very important for teachers to practise what they preach in as much as teacher self-care is as important as signposting children and young people who are struggling with mental health issues. A 2016 survey by the National Union of Teachers (NUT) found almost half of teachers had sought help from their doctor for stress-related condition. Teacher stress and burnout and those leaving the profession due to conditions like stress do not help to create an environment that is supportive of good mental health in the classroom. Teacher wellbeing is so important and building their own resilience is one way that teachers can start to embed good mental health in their practice. If you are doing it yourself it will be easier to help and show children how to do it if they come to you for advice!

Teachers simply being there and offering a safe space and first point of contact for many children is important. Listening and signposting can be so valuable for those pupils taking the first step and teachers should not be put off by any personal perception of a lack of expertise in mental health – a small amount of knowledge or understanding of what to do next is more than enough. In some respects, teachers should feel almost privileged that a student has chosen to come to them, someone they feel they can trust and talk to.

A poll conducted as part of a webinar held for educational practitioners found that rather than requiring more information about mental illness, what teachers actually wanted was more practical examples of how to apply support in the classroom and how to embed mental health into their teaching and the learning of their students.

A unique opportunity

Schools and teachers are on the front line of public services and have a unique opportunity through regular contact with children to help to build and promote resilience among pupils, and embedding this within the whole school can be an effective way of ensuring pupils feel the benefit without being singled out. Taking nurturing approaches to learning and teaching, and promoting the creation of trusting relationships is key to some of the already effective practice going on in schools. Sharing the learning and best practice that is already happening will be vital to ensuring that support for children suffering from mental ill health improves and adapts to changing needs in the future.

If you liked this article, you may also be interested in reading:

Writing and recovery: creative writing as a response to mental ill health

Addressing social mobility through education – is it enough?

The Changing Room Initiative: tackling the stigma of poor mental health in men through sport

Follow us on Twitter to find out which topics are interesting our research team

Designing for positive behaviours

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St Paul's Cathedral, London, England

By Heather Cameron

“We shape our buildings; thereafter they shape us” – Winston Churchill, 1943

This much borrowed saying from the former prime minister was made during the 1943 debate over the rebuilding of the House of Commons following its bombing during the Blitz. Although many were in favour of expanding the building to accommodate the greater number of MPs, Churchill insisted he would like it restored to “its old form, convenience and dignity”. He believed that the shape of the old Chamber was responsible for the two-party system which is the essence of British parliamentary democracy.

Indeed, it has since been widely acknowledged that the built environment has a direct impact on the way we live and work, thus affecting our health, wellbeing and productivity. A new report from the Design Commission, which opens with Churchill’s statement, is described as “a very valuable contribution” to the debate on how the design of the built environment can influence the way people think and behave, “making a healthier, happier and more prosperous and sustainable country”.

Impact of design

The report, which follows a year-long inquiry, is described as providing “solid evidence in difficult areas” on what it is in the built environment that makes people’s lives better. Evidence was gathered on four specific areas believed to be the most important to national policy:

  • health and wellbeing
  • environmental sustainability
  • social cohesion
  • innovation and productivity

It is suggested that design acts at two levels: it can affect individual choices of behaviour, which can then affect health and sustainability; and it can affect the way people are brought together or kept apart, which can then affect communication and creativity, or social cohesion.

The inquiry therefore looked into how people’s behaviour, health and wellbeing are affected by their surroundings; the role design can play in encouraging environmentally sustainable behaviours; the role design can play in social cohesion through its effects on creating or inhibiting co-presence in space; and how the design of work environments can drive innovation and improve efficiency, therefore tackling the current ‘productivity crisis’.

The evidence

The evidence highlights the built environment as “a major contributing factor to public health”. A range of public health issues, including air pollution and obesity, were suggested to be directly linked to factors within the built environment. Other recent research has similarly highlighted this link between health and urban design.

Evidence of the potential for design to positively influence sustainability behaviours, such as greater cycling and walking activity, was also highlighted, with New York cited as a good practice example.

Providing evidence on social cohesion, a senior university lecturer stated that “to divorce the physical from the social environment is inappropriate”. Other submissions referred to the “alienating effects” of various aspects of modern corporate life on civic participation, including estate management, crime and safety, the perceived negative impacts of poorly-conceived urban planning and poor or no maintenance.

Well-designed places, on the other hand, are suggested to improve access and facilitate social cohesion. Nevertheless, the evidence also noted that regardless of how well designed a place may be, “neglecting its aftercare will lead to antisocial behaviour and environmental damage.”

The relationship between the built environment and productive behaviours is supported by substantial evidence, according to the report. In the context of the UK, a lack of access to daylight and fresh air is cited as a reason for offices failing to get the best out of their workers. One study cited, indicated an increase in levels of both wellbeing and productivity in office environments with so-called ‘natural elements’.

Policy – “muddled and fragmented”

While there is evidence of good practice throughout the UK, a principal argument from the report is that more needs to be done.

Policy making for the built environment has traditionally been “muddled and fragmented”, according to the report. It suggests that there is a lack of understanding of the significance of the influence of the built environment on behaviour among policy makers at all levels and therefore makes recommendations for central government, local government and the private sector.

It argues that the relationship between government and local authorities requires reconsideration, calling for greater power at local government level.

Despite encouraging steps with regard to devolution in positively impacting behaviour and quality outcomes, such as in London, it is suggested that more can be done in terms of better collaboration between all stakeholders.

It is also noted that as national policy will be now be conducted in the context of Brexit, adaptation of the regulatory regime will be required.

Final thoughts

The key message from the Design Commission’s inquiry is evidently that the design of the built environment is particularly important in the context of current challenging times for the UK:

 “The way we design our built environment could be one of our greatest strengths in navigating the course ahead… If we get this right, we can build a Britain that is healthier, happier and more productive.”

If you enjoyed reading this, you may be interested in some of our previous posts on related topics:

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Beating the back to work blues

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Moving Crowds 4

The first journey into work after the Christmas break has to be one of the most painful journeys of the year. Overfed, possibly hungover, still angry at that sly comment your distant relative made across the dinner table a week ago, you and many others return to work at the start of January with the glow of the next set of bank holidays seeming very far in the distance (FYI the next bank holiday is Good Friday on 14th April – yes, APRIL *sobs*).

It’s no surprise then, that January is the time of the year that sees the highest rates of divorce. This is the month heralding some of the highest stress rates of the year, and is the lowest point in the calendar for many people who face daily battles with mental health. A researcher at Cardiff University, Dr Cliff Arnall has even created a formula to work out that 24th January is the “most depressing day of the year”.

Mental health takes centre stage at work

It’s therefore apt that as many of us spend much of our time at work, there has been an increasing recognition of the role of employers in supporting mental health.

In October 2016, Business in the Community published its 2016 Mental Health at Work report, which included a toolkit for employers. The report highlights the damage that concealing their condition can do to people with mental health problems, as well as the level of support that should be made available to employees to help promote positive mental health and wellbeing in the workplace.

Recommendations made in the report include:

  • Talk – Organisations and employers should break the culture of silence that surrounds mental health, particularly in the workplace by talking the Time to change employers pledge
  • Train – Organisations and employers should invest in training to ensure basic mental health literacy for all employees in all areas of the business
  • Take action – Organisations and employers should “close the gap” by asking all staff about their experiences of their own mental health at work and how any issues have been dealt with. Understanding the perceptions that staff have of how the company supports mental health generally across the organisation, can help identify steps to improve/ change practice if necessary.

Employers role in removing stigma

Ensuring good mental health in the workplace affects all levels of staff, from senior management to the newest members of staff who are still training or serving a probationary period. Multiple reports, including those by ACAS, CIPD, MIND and The Work Foundation, have stressed the importance of employers setting an example to their staff. That includes senior staff recognising when they need to take time to support their mental wellbeing too.

The Chartered Institute of Personnel and Development’s (CIPD) Absence Management Report for 2013, showed that stress is one of the biggest causes of long-term absence in the workplace. The report also showed that it impacts staff at all levels:

  • 40% of respondents said that stress-related absence increased over the past year for the workforce as a whole
  • 20% said it increased for managers
  • 1 in 8 reported a rise for senior managers
  • Only 44% would feel confident enough to disclose unmanageable stress or mental health problems to their current employer or manager.

The report suggested that if senior managers acknowledged their own mental health issues, it would remove some of the stigma associated with asking for help with mental health in the workplace. However, doing this requires a significant culture shift in how many organisations are run – which could take years. The Work Foundation, commenting on the 2016 version of the CIPD report, found that:

“Effective management of mental health in the workplace can save around 30% of costs felt by employers.  Line managers have a really important role to play in creating an environment where employees feel safe to disclose with the knowledge that the organisation will do something to help them.  Managers need to have a positive employment relationship where open and honest conversations can be had to discuss any required adjustments and provide that supportive environment.”

Using “blue Monday” to initiate conversations on mental health

This year “Blue Monday” falls on the 16th January. It may be called the worst Monday of the year, but employers are being encouraged to use the publicity around it to create opportunities for employees to discuss mental health in the workplace.

Questions to ask could be: what makes them stressed, what makes them anxious, how can the office environment be changed to improve the wellbeing of employees? There are also ideas for activities to help staff “beat the blues”, including lunchtime exercise, healthy eating and talking to colleagues about things other than work.

Specific sectors have also begun to initiate schemes to try to improve mental health and well being. Mates in Mind is a programme to be launched in early 2017 by the Health in Construction Leadership Group with the support of the British Safety Council. Modelled on an Australian programme, it is a sector-wide programme intended to help improve and promote positive mental health across the construction industry in the UK.

In social work, too, informal peer mentoring schemes have sprung up organically in many offices, with co-workers giving each other support when they need it, often in an informal capacity. More formal schemes have been set up to help social workers monitor and feel safe when talking about their mental health to colleagues and superiors. Feedback indicates that the low rate of retention of social workers is, in part, due to stress caused by secondary trauma or excessive caseloads.

 

So, as we trudge back to our desks for the first working days after Christmas, it is perhaps worth keeping some of these ideas in mind. Employers are keen to talk about mental health, but they also need the input of staff in order for them to work.

Putting some of these ideas into practice, may also go some way to improving the situation of many with hidden mental health conditions in the workplace who don’t feel confident enough to speak openly about it. We needn’t wait for the next bank holiday to improve our mood, small changes can make a big difference to wellbeing in the workplace!

Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other workplace mental health articles: 

Managing mental ill health in the workplace

Ending the stigma around anxiety

Health Champions – “unlocking the power of communities”

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By Heather Cameron

“On the societal level, we must understand that health is not an individual outcome, but arises from social cohesion, community ties, and mutual support.” Dr Gabor Maté

Health inequalities have long been an issue in the UK and despite continuous government commitment to tackling them, they continue to persist.

It is estimated that avoidable illness costs around £60 billion and that 1 in 4 deaths are preventable with the adoption of healthier lifestyles. Calls have therefore been made for radical changes in the approach to public health by improving health and wellbeing outside of the core public health workforce.

This is just the approach of the Community Health Champion model, developed by Altogether Better, which has demonstrated not only the positive impact on health but the social value of such an approach.

What are health champions?

Health Champions are volunteers from all walks of life who are provided with accredited training and support so they can undertake health promotion activities within their communities to reduce health inequalities and improve the health of the local population.

The Community Health Champion role began as a five year Big Lottery Funded programme (Wellbeing 1) in 2008. Over 18,000 Health Champions were recruited, trained and supported between 2008 and 2012, reaching over 105,000 people.

Through a combination of their training and own personal experiences, these volunteers empower and encourage people within their families, communities and workplaces to take up healthy activities, create groups to meet local needs and can signpost people to relevant support and services.

Challenges

While Wellbeing 1 succeeded in reaching many people in need, the programme also raised two specific challenges: in almost all cases, the work being done was invisible to the NHS; and securing ongoing funding to continue the support was difficult.

Peer support was later identified as the most appropriate way of trying to connect communities with health services.

Following this recognition and the success of the original model, further lottery funding was awarded to develop the Champion model and use it to engage champions, communities and health services (Wellbeing 2).

Co-production of health and wellbeing outcomes

The model was applied to health services specifically with the aim of addressing the apparent disconnect between the NHS and community-based services. It helps connect both patients with support in their communities and professional practices with those communities.

Many citizens have volunteered in different ways and in different settings. These include:

  • Practice Health Champions working closely with their General Practice to create new ways for patients to access non-clinical support
  • Youth Health Champions where children and young people are recruited, trained and supported to help young people more actively engage with and influence their own and their community’s health
  • Pregnancy and early years Health Champions who are interested in giving children a better start
  • Health Champions working within a specialist, hospital-based NHS service
  • Senior Health Champions who engage with older people, offering a complimentary approach to more formal programmes

Community-based health improvement initiatives such as this could help to strengthen community-professional partnerships and cross-collaboration among health, social and other services. And this in turn could lead to a reduction in health inequalities.

Positive outcomes

According to a recent evaluation of the Health Champions programme, Wellbeing 2 has resulted in a range of benefits:

  • 86% of champions and 94% of participants in the programme reported increased levels of confidence and well-being;
  • 87% of champions and 94% of participants in the programme acquired significant new knowledge related to health and well-being;
  • 98% of champions and 99% of participants in the programme reported increased involvement in social activities and social groups;
  • 95% of practice staff involved with the programme would recommend it and wish to continue.

Other benefits included reduced social isolation, increased levels of exercise/healthy eating and feeling physically better. One champion reported “this has helped me more than any medication might.”

Success stories  include the work of a cycle champion who has improved her own health and wellbeing, encouraged over 70 other people to improve theirs through taking up cycling, provided cycle training to over 50 people in 6 community groups and provided specific detailed help to 5 people.

Other successes have involved volunteers setting up football training, providing support to women with mental health issues, providing advice and support to ethnic minorities and providing advice on healthy eating.

In terms of monetary value, an  analysis of the social return on investment (SROI) of a series of Altogether Better project beneficiaries found a positive SROI of between £0.79 and £112.42 for every pound invested, highlighting the potential value of these initiatives to funders.

Final thoughts

At a time of increasing demands on health services and with the relentless squeeze on public sector resources, perhaps the move towards greater community empowerment and collaboration across sectors is the right one. After all, as I’m sure we’d all agree, prevention is better than cure.

If you liked this blog post, you might also want to read Heather’s earlier post on social prescribing

Follow us on Twitter to see what developments in policy and practice are interesting our research team.

 

 

Social prescribing – just what the doctor ordered?

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blue toned, focus point on metal part of stethoscope

By Heather Cameron

It is widely acknowledged that wider social, economic and environmental factors have a significant influence on health and wellbeing. According to recent research only 20% of health outcomes are attributable to clinical care and the quality of care while socioeconomic factors account for 40%.

With increasing pressures on GPs and lengthy waiting times a real issue for many, particularly those with mental health conditions, social prescribing could represent a real way forward.

The government clearly recognised the importance of social prescribing in its new deal for GPs announced earlier this year, which made a commitment to make social prescribing a normal part of the job.

In response to a recent Ask-a-Researcher request for information on different approaches in social prescribing and evidence of what works in the UK, it was interesting to find that despite the recognition of potential value, there has been little evaluation of social prescribing schemes to date.

Much of the material found focused on specific interventions and small-scale pilots and discussion around implementation. A new review of community referral schemes published by University College London (UCL) is therefore a welcome addition to the evidence base as it provides definitions, models and notable examples of social prescribing schemes and assesses the means by which and the extent to which these schemes have been evaluated.

So what is social prescribing?

Social prescribing means linking patients with non-medical treatment, whether it is social or physical, within their community.

A number of schemes already exist and have included a variety of prescribed activities such as arts and creative activities, physical activity, learning and volunteering opportunities, self-care and support with finance, benefits, housing and employment.

Often these schemes are delivered by voluntary, community and faith sector organisations with detailed knowledge of local communities and how best to meet the needs of certain groups.

Social and economic benefits

Despite a lack of robust evidence, our investigation uncovered a number of documents looking at the social prescribing model and the outcomes it can lead to. Positive outcomes repeatedly highlighted include:

  • improved health and wellbeing;
  • reduced demand on hospital resources;
  • cost savings; and
  • reduced social isolation.

According to the UCL report, the benefits have been particularly pronounced for marginalised groups such as mental health service-users and older adults at risk of social isolation.

A recent evaluation of the social and economic impact of the Rotherham Social Prescribing Pilot found that after 3-4 months, 83% of patients had experienced positive change in at least one outcome area. These outcomes included improved mental and physical health, feeling less lonely and socially isolated, becoming more independent, and accessing a wider range of welfare benefit entitlements.

The evaluation also reported that there were reductions in patients’ use of hospital services, including reductions of up to a fifth in the number of outpatient stays, accident and emergency attendances and outpatient appointments. The return on investment for the NHS was 50 pence for each pound invested.

Similarly, the Institute for Public Policy Research (IPPR) has recently argued that empowering patients improves their health outcomes and could save money by supporting them to manage their condition themselves.

IPPR suggests that if empowering care models such as social prescribing were adopted much more widely throughout the NHS we would have a system that focused on the social determinants of health not just the symptoms, providing people with personalised and integrated care, that focused on capabilities not just needs, and that strengthened people’s relationships with one another.

Partnership working

With a continued policy focus on integrated services and increased personalisation, social prescribing would seem to make sense. In addition to providing a means to alternative support, it could also be instrumental in strengthening community-professional partnerships and cross-collaboration among health, social and other services.

The New Local Government Network (NLGN) recently examined good practice in collaboration between local authorities, housing associations and the health sector, with Doncaster Social Prescribing highlighted as an example of successful partnership working. Of the 200 referrals made through this project, only 3 were known to local authority and health and wellbeing officers, showing that the work of social prescribing identified individuals who had otherwise slipped through the net.

And with the prospect of an ageing population and the health challenges this brings, a growing number of people could benefit from community-based support.

As Chair of Arts Council England, Sir Peter Bazalgette, notes “social prescribing is an idea whose time has come”.

Follow us on Twitter to see what developments in policy and practice are interesting our research team.

Further reading: if you liked this blog post, you might also want to read Heather’s earlier post on the health and wellbeing benefits of investing in public art.

Healthy places, healthy people?

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by Lesley de Blieck

“If 75 % of people failing to exercise enough across the country did meet recommended levels of walking, £675 million could be saved each year”. RIBA

Section 12 of the Health and Social Care Act 2012 has given local authorities in England responsibility to improve the health and wellbeing of local people. Continue reading →