Social prescribing for whole person care

Responding to an anxiety epidemic, there’s a growth in social prescribing with a spiritual wellbeing element. Esther Platt explores how it's working out locally.

Esther Platt

Esther works as a Senior Consultant for the Good Faith Partnership. She sits in the secretariat for the ChurchWorks Commission.

Two people sit at a table with their hands resting on top of it. One speaks to the other

Photo by Christina @ wocintechchat.com on Unsplash

Since 2001, Mental Health Awareness Week has been marked once a year in May. This year, the theme was anxiety - an increasingly relevant topic in a country that has endured three years of world-changing crises and the soaring cost of living. Research from the Mental Health Foundation has found that 1 in 10 UK adults feel hopeless about financial circumstances and more than one-third feel anxious.

For centuries, it has been recognised that spiritual well-being is closely tied to mental well-being. By spiritual wellbeing, I don’t mean organised religion. I mean our sense of relationship to a higher-power or reality beyond our own, and our sense of purpose and meaning in life, as Craig Ellison outlines it as in his paper Spiritual Well-Being: Conceptualization and Measurement.

In Man’s Search for Meaning holocaust survivor Victor Frankl compellingly makes the case that in a world of suffering, our survival depends on our sense of purpose, meaning and hope. Frankl coined the term ‘the self-transcendence of human existence’ by which he explained that human beings look for meaning beyond themselves, either in a cause, a person to love, or a higher power.

With an increased understanding of the holistic nature of wellbeing, and the value of spirituality, a new way of looking at health is emerging.

While modern psychologists are still building a clinical-grade evidence base on the value of spirituality, there is clear agreement that spiritual wellbeing is crucial for a good quality of life, especially for those who are facing adverse life events, as you can read on the US National Library of Medicine web site. Traditionally, health provision in the UK has focused exclusively on the physical, and more recently the mental. However, with an increased understanding of the holistic nature of wellbeing, and the value of spirituality, a new way of looking at health is emerging.

Social prescribing is one way in which this is being done, and across the country.

In social prescribing, local agencies such as charities, social care and health services refer people to a social prescribing link worker. Social prescribing link workers give people time, focusing on ‘what matters to me?’ to coproduce a simple personalised care and support plan. This involves ‘prescribing’ individuals to local community groups such as walking clubs, art classes, gardening groups and many other activities.

Churches are playing a crucial role making social prescribing happen. St Mary’s Church in Andover, offer a wellbeing course to members of the community who have been directed to them through the local GP surgery.

Members of Revival Fires Church in Dudley have been trained to offer Listening and Guidance support to those who are referred by a GP.

Beyond social prescribing, St John’s Hoxton in London offer the Sanctuary Mental Health course to their community which gives people an opportunity to share their experiences and find solidarity in their struggles.

Church provides a space where the breadth of our wellbeing, our desire for purpose, community and hope can be supported in a way that the NHS does not have capacity or experience to deliver. As the Archbishop of Canterbury, Justin Welby, writes

"The issue of mental health is one that requires a holistic approach on an individual basis, incorporating as appropriate psychiatric, medical and religious support’.

Olivia Amartey, Executive Director for Elim, an international movement of Pentecostal churches adds,

‘I am convinced that there is no other organisation on earth that cares for the whole person, as well as the church. Its engagement with the statutory authorities, focussed on individuals’ well-being, provides an invaluable opportunity for a synchronised partnership to the benefit of all our communities.’

Jesus told his followers, ‘I have come so that you can have life and have it to the full’. This is the hope that animates churches. Christians find meaning and purpose in the hope of life, peace and justice that Jesus gives. Church can be a space where the complexity of hurt and suffering is acknowledged, and where we can find solidarity and support in the presence of those who can help us find purpose and meaning.

At ChurchWorks, a commission of leaders from the 15 biggest church denominations in the UK, we are excited by the prospect of more churches providing this space. On 18th May we held ChurchWorks for Wellbeing, in which we gathered over 300 church leaders to explore how the church can bring hope to our communities in this time. We shared stories of small and simple conversations, where offering a listening service, an art class or a food pantry enabled churches to give people in their community space to be, to grieve, to process and to grow. From the conference, it is our hope that we will see hundreds more churches start to engage in social prescribing and welcome their communities to access holistic wellbeing support.

At a time when anxiety is rife, and it is so easy to feel despair and hopelessness, the church offers a vital resource to us: a place where our spiritual wellbeing can be nurtured, where we can find purpose, where we can find community, where we can find hope.

Article

Care

Change

26 July 2024

6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.