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Over 15 million people in England suffer from long-term conditions (LTCs) related to their health. They experience poorer health outcomes and reduced quality of life as a result. They are proportionately higher users of health services (GP appointments, prescription drugs, outpatient services and in-patient hospital bed days). LTCs account for 70% of health and social care costs in England, and around 55% of GP appointments are with patients with one or more LTCs.
West Newcastle upon Tyne is among the 40th most deprived areas in England. 18% of residents are recorded as living with a long term condition (LTC) and the receipt of sickness or disability-related benefits is higher than the national average.
Enabling people with LTC to self manage their condition can improve their life quality and reduce demand for health and care services, but health authorities often lack the funding to support this kind of service.
Social prescribing is increasingly being seen as a way of addressing complex health issues, particularly for people with long-term conditions. While some small scale community-based activities have been funded in the past by local and health authorities, the evidence base for this approach remains limited. Taking a SIB approach has enabled long-term funding for social prescribing on a scale that wouldn’t have been funded otherwise.
Ways to Wellness is a social prescribing intervention targeting people aged 40-74 living in areas of high socio-economic deprivation who have long term health conditions. Ways to Wellness Link Workers offer support to patients referred by primary care, helping them to identify meaningful health and wellness goals, and provide support to help them access community and voluntary groups and resources. The Ways to Wellness intervention is predicted to save £10.8 million in secondary care costs, and a further £13.6m to other public services.
A Newcastle University report found that once engaged with the service, patients reported positive physical and behavioural changes, including weight loss, increased physical activity and improved mental health. Patients also reported increased self-confidence and control, reduced social isolation and greater resilience.
The report concludes that: "findings suggest that tackling complex and long-term health problems requires an extensive holistic approach not possible in routine primary care. This model of social prescribing, which takes into account physical, mental health, social and economic issues, was successful for patients who engaged with the service. Future research on a larger scale is required to assess when and for whom social prescribing is clinically and cost effective".
Maximum outcome payments
Newcastle Gateshead Clinical Commissioning Group, Commissioning Better Outcomes Fund, Cabinet Office Social Outcomes Fund
Ways to Wellness (First Contact Clinical & Mental Health Concern)
Bridges Fund Management
Social Finance (financial modelling & designing the metrics)
1. Improved self-management of LTC, leading to greater sense of well-being, reduced isolation and fewer GP visits (as measured through Triangle Consulting's Well-being Star) – 30% of the outcome payments)
2. Reduced cost of secondary healthcare services as a result of improvement in self-management of LTC (70% of the outcome payments), measured against a counterfactual
A Deep Dive Report produced by Ecorys UK and ATQ Consultants as part of the Commissioning Better Outcomes Fund Evaluation highlights that many outcome metrics were tried, but were discounted for either being unmeasurable or not a direct or reliable proxy for the outcome sought. Due to the innovative nature of the project there was limited available evidence to draw on. Although all parties appeared on board with the measurement approach, stakeholders commented that the approach will not capture all the potential cost savings generated by the project.
The project has had to restrict its referral criteria based on what data can be accessed and they did not fully know whether the outcomes metrics would work. Quite a few stakeholders were nervous about some aspects of the measurement approach. Specifically, stakeholders raised two concerns:
Source: Tara Case. September 2019. Presentation. Social Outcomes Conference 2019.
Voluntary Organisations' Network North East (VONNE) commissions initial work to explore the potential of using SIBs to implement social prescribing interventions
A steering group, which included the Newcastle West CCG (now part of Newcastle Gateshead CCG), is set up to develop the SIB proposal
Commissioning Better Outcomes Fund and Social Outcomes Fund application submitted and subsequently approved for funding
Refinement of operational plan and financial model
Discussion with prospective social investors
Outcome metrics and PbR structure developed and refined
Service provider procurment process
Social investor (Bridges Fund Management) agreed
Final agreement to fund from Commissioning Better Outcomes Fund and Social Outcomes Fund
Contracts between CCG, Ways to Wellness and Bridges Fund Management signed
Contracts between Ways to Wellness and service providers signed
SIB is launched
Service is mobilised
Service is launched
Local health commissioning is complex due to the split between the CCG, NHS England and Public Health, the last of which is further split between Public Health England and local authorities. This means that different commissioners benefit from different outcomes. Ideally, the SIB would reflect the benefits of improved outcomes to all the commissioners, all of whom would contribute payments based on the achievement of those outcomes. This proved challenging, however, as no other public bodies were willing to co-commission the SIB due to funding constraints. Consequently, only the direct benefit to the CCG is reflected in the SIB outcomes and business case.
Creating an intervention that is funded only by the organisation that reaps the direct benefits is a challenge, and limits the scope of the SIB. It remains challenging for a local commissioner to fund outcomes which generate benefits to other commissioners – in this case NHS England and the local authority – and/or to persuade such beneficiaries to make a contribution to payments. The fragmentation of health commissioning means that some of the outcomes and benefits of the SIB (e.g. to primary care) are not being measured and paid for.
The Ways to Wellness SIB is a pioneering collaboration between local GPs, the CCG, local VCSE organisations and social investors. Ways to Wellness Ltd, the trading arm of the Ways to Wellness Trust, is the social prime contractor in the SIB and manages the contracts with the CCG, investors and the four service providers. It acts as the central contract management body for the work. Its main roles are to:
Ways to Wellness Ltd also:
Link Workers are central to the Ways to Wellness service. They provide support and signposting to help service users to achieve their goals and address their concerns or issues, and are instrumental in establishing effective relationships across the system.
A study undertaken by the Institute of Health and Society at Newcastle University found that the report and quality of the relationship between the Link Worker and service user was central to achieving well-being, as well as key to successfully linking service users into a wide range of community, voluntary and NHS services identified as relevant to their situation. The Link Worker social prescribing programme engendered feelings of control and self-confidence, reduced isolation and led to positive physical changes and mental health, greater resilience and effective coping strategies. The study shows that the key elements of the model are that it is:
For further information on the Newcastle Ways to Wellness SIB, you can contact:
Communication with Tara Case, Chief Executive, Ways to Wellness, 2018.
Page last updated: October 2019.
Ways to Wellness slides, GO Lab West Mids Regional Conference, 2018Download PDF
Ways to Wellness SIB - A Deep Dive Report, Commissioning Better Outcomes Fund Evaluation, 2015Download PDF
Better Commissioning for Healthy Lives Symposium: Summary Report, 2017Download PDF
A review of the evidence assessing impact of social prescribing on healthcare demand and cost implications, 2017Download PDF
Social prescribing for long term conditions slide, GO Lab Better Commissioning for Healthy Lives Symposium, May 2017Download PDF
Ways to Wellness - Data TemplateDownload XLSX