Social prescribing- the COVID effect?

I put a post onto LinkedIn recently about re-engaging with social prescribing (SP) and got the biggest reaction I’ve had to any posting, which caused me to think that actually the SP programme is really getting some traction. Could this also be because of COVID and the health and care system recovery with people looking for a demand management structure for their response?

The point of my original post was to argue that the nationally mandated Prescriber Link Worker is a big job- too big and at the same time not big enough…..let me explain further….

The government finally recognised the value of SP in the NHS Long Term Plan, (LTP) this was despite SP running successfully albeit on funny-money and a local basis right across the country, and report after report recommending its mainstream funding, and expansion.

Unfortunately the government’s 7 year austerity experiment which preceded the NHS LTP had dramatically reduced the capacity of voluntary sector provision to respond to increased demand. Just as the NHS was getting its act together in terms of protocols and referral pathways, those services it would wish to refer to, have closed down; from CAB and benefit advice to befriending clubs and even long term condition support organisations.

Back to the Link Workers then, so they need to carry a caseload and develop local referral networks, ensuring any such provision is safe of high quality and outcome focussed. As I say I think these are at least 2 separate jobs, but actually the real challenge in this work is to enable the sector to rebuild itself and provide the infrastructure for self help to occur.

So where would I start if I was running an SP programme:

  1. Establish a referral pathway which, with patients consent, places them in a virtual waiting room with access to a range of self care material: online mental health support, virtual befriending groups, hotline to CAB or Housing support. Allow case-workers including the Link Worker to offer interventions and support without taking full responsibility for the patient as this remains with the patient at all times using self care principles .
  2. Enter into a partnership with a voluntary sector Local Infrastructure Provider (LIP) to host the SP and to co-design a network of case workers and advice and support provision
  3. Make it clear to patients on referral that there is a cost to the provision of services and that they may have to pay towards activity costs such as yoga in order to ensure the programme is sustainable into the future
  4. Join with other to support local authorities to lobby government for the return of the funding lost to them to enable them to support the rebuilding of the voluntary and community sector

Andy June 20

Andy Mills has worked with social prescribing schemes for over 20 years. Give him a call to talk over issues and solutions: 07887 653 280

What does your customer base look like now?

On the 23rd of March, going into lockdown in response to the COVID-19 pandemic many of us lost the ability to plug into the understanding of our businesses that we generate from our daily interactions with colleagues, customers, and suppliers.

I’m sure like me you’ve heard lots of stories about businesses adapting to their new trading environment, whether this be by:

  • switching markets from wholesale to direct to public;
  • moving from supplying a consumer product to supplying the NHS/care sector; or
  • just pausing service provision altogether and hoping customers are still there when you open up.

Organisations with marketing and research capacity will be undertaking customer, partner, stakeholder insight right now to re-establish contact and discover how their market may have changed in the last 2 months. Which is all well and good for those with those resources, but as a small business how can this be done quickly, simply and at low cost?

Here are five top tips:

  1. INVEST TIME: Dedicate some time to this, it’s an investment in the business and worth thinking about. Don’t underestimate the importance of customer and market intelligence to even the smallest business.
  2. REVIEW YOUR EXISTING RESOURCE: Evaluate your customer/partner/stakeholder contacts to ensure they are held on an application which can be easily accessed and allow you to contact them rapidly about issues that matter via email, and social media
  3. THINK ABOUT WHAT YOU NEED TO KNOW; Develop between five and eight ‘closed’ questions i.e. those with a yes/no answer, about your business and try these out on a trusted business contact…..they may advise you that you are asking about the wrong part of your business offer!? Leave some space for some free text too but don’t overdo the questions as even your best friends will be put off giving you honest feedback
  4. ASK CUSTOMERS WHAT THEY THINK: Start by using your email contact list and send them the questions in a format which is easy to use and generates automated aggregated analysis i.e. use something like SurveyMonkey or Snap surveys
  5. TAKE SOME TIME TO LISTEN TO AND UNDERSTAND WHAT YOUR CUSTOMERS TELL YOU: Spend some time looking at the responses and free text and ask yourself if they correspond to your previous business plan. If not, you’ve got some insight to confirm you may need to adapt moving forward

If this sounds like its outside of your experience or you need this doing pronto think about using a local marketing company/research house to help you.

 What can we do for you?

Rapid high level insights into the key market trends in your sector through digital face-to-face or telephone tactics;

  • Simple and effective, standardised satisfaction surveys with your existing customer base;
  • Insight on national and regional trends relevant to your business through a one off or regular questions on our ‘omnibus’ survey’;
  • Customised online surveys or depth interviews with new or existing customers to inform your planning.

Who are we?

PH5point0is a proven collaboration between experts in, social research, consultation, and engagement. We concentrate on business strategy, engagement, consultation, service design and research.

Our aim is to help organisations involved in delivering new approaches to strategy, operational management and implementation based upon an understanding of what works.

The principals of PH5point0 are Andy Mills from and Andy Wright from

Mason believe in partnering with you to create PR & Marketing strategies that transform your business. Nick from Mason media says: ‘we are pleased to partner on this initiative which we think will be good for business following lockdown’

If you need help, advice or actionable customer insight right now give Andy Mills at PH5point0 a call.

 Why PHpoint0? Because that’s smack bang in the middle of the pH value for coffee, and our team love nothing more than good coffee and stimulating chat.

What has what happened in Iowa got to do with us?

I’ve just given a really bad/rose tinted explanation of the Iowa caucus process to a colleague, (there’s a better one here). My colleague was however, very keen to point out its pitfalls: its exclusive by design or by accident, it has a poor track record (its a bit unfair to base this view on the 2020 event!) and its expensive. These were the 3 I can remember as he went on a bit

But, I’d argue that these issue can be managed and the caucus approach is worth sticking with, as every democratic process has its downsides ref Dan Jellinek’s wonderful book: People Power- a user’s guide to democracy

At its heart the Iowa Caucus is a demonstration of a participative democratic process and sits alongside many other forms of governance which have been tried/theorised and neatly summarised here

 Who could argue with people being given the opportunity to publicly discuss, persuade and/or concede to their neighbours in a moderated safe place, important matters which affect them and their communities? Now, it looks the wheels came off in Iowa when someone decided a digital application would speed things up/improve the process. (by the way it seems this was untried technology from a company with no track record in supplying systems such as this, so I’d suggest there was something wrong with procurement rather than the ‘modernising’ of the approach). There’s a great review of what went wrong here

 So is there anything we can learn from the Iowa Caucus? , well maybe digital is not best in this instance but more importantly participative democracy can provide some different solutions:

We have used some participative budgeting process when we worked with Mutual Gain on participative budgeting. We think the time may have come for processes such as these as the public sector struggles with ever more difficult decisions about resourcing of services. We might not need an Iowa style  Caucus but we sure do need greater participation from citizens in how public resources are committed.

If you are interested in the Mutual Gain Commission Cubes product give them a call here


A friend has just got a really swanky health economics job and we’ve just had a fun chat about doughnuts and donuts. In the end we both agreed donuts are great (in moderation though………. we believe in public health) but Kate Raworth’s book: Doughnut Economics- seven ways to think like a 21st century economist, is even better:

I’ve had a stab at applying Kate’s ‘seven ways’ to health and care as I think they provide a framework to think differently about how we organise and deploy health and care resources…..what do you think?:

Change the goal: yes, lets focus on what matters to people not arbitrary 4hr/18 week targets in health and access thresholds in social care. There’s plenty of evidence to say people are a) willing to wait for the right service at the right time to get the best outcome:  and b) as taxpayers, pay more for health and social care as long any new tax is hypothecated

See the big picture: This is about system thinking and many places have already embraced the integration of health and social care (although not many health bodies are willing to allow health budgets to merge with  adult social care budgets!) There maybe more scope to widen the current ‘closed’ system and spread the impact of social care budget pressures. Afterall the system should absolutely contain education, housing, employment, transport, criminal justice, regeneration etc etc etc. have a look at what Cheshire West Integrated Care partnership are up to in this area:

Nurture human nature: wider system engagement would mean that the 80% of our lives, that we live outside of health and care services, can be brought to bear to keep us well; in safe places to live, in sustainable housing/communities with some friends and useful things to do which pay the bills.

Get savvy with systems: we hold masses of data on eachother and people expect us to use it to provide care (and plan services?) but we are loath to do so because we misunderstand public concern (some of this is our fault ). Risk stratification should be the starting point (see below)

Design to distribute; the outcome of savvy systems should be more appropriate resource allocation and who can argue with resources allocation based on need? Joint Strategic Needs assessments provide a good place to start this conversation.

Create to regenerate; The recovery movement where people have struggled with mental health and substance use are some really good examples of regeneration

Be agnostic about growth: Now, I’ve proposed increased taxation which requires people to be in work to have the resources to pay which in turn means we need to ensure jobs exist. However, doughnut thinking suggests we value jobs differently so caring/volunteering could/should have greater value then jobs which define existing definitions of a successful economy. As Kate Raworth says: ‘we know full well that we have the know-how, technology, and financial means to end poverty in all its forms should we collectively choose to make that happen’……we are all economists now.

So what…..well, as described above some of this stuff is being implemented or at least thought about already. Why not audit where you are with Kate’s ‘audit’ or better still ask C.Co to give you a hand…….It may give you a fresh perspective. You don’t need to go all misty eyed about the future funding model for health care, you could focus on a service , a pressure or an opportunity?

Where we started out wasn’t where we ended up

We’ve recently completed  a commission in the North of England, which in common with the way in which strategy development can take place, where we started out wasn’t where we ended up. Initially focussed on ‘preventing mental ill-health’ we ended up proposing some far reaching wellbeing measures within strategic planning for housing, jobs, green spaces and recommending a ‘place-making’ approach. We moved from health is healthcare to health is anything but the work of the NHS and care providers. We will post a link once the strategy is signed off.

Now this isn’t new, indeed we took our lead from the and the work of the West Midlands Combined Authority and the Liverpool City Region whom are all on the same page, although its interesting to note how easy it is to retreat into what we know when you start to examine the transformation work outlined…….many of the actions relate to health and care service redesign, missing the opportunity to focus on place making as set out in their vision documents.

So what is place making: Research by the University of Wisconsin Population Health Institute (2016) has found that only 10 to 20 percent of a person’s health is related to access to care and the quality of services received. In comparison, over 40 percent of the factors that contribute to the length and quality of a person’s life are social and economic, while another 30 percent are health-related behaviours directly shaped by socio-economic factors, and an additional 10 percent are related to the physical environment. Over the last several decades, a growing body of literature has emphasised the importance of “place” to people’s health, with a frequently cited finding suggesting that a person’s postcode can be a larger determinant of his or her health than any other factor, including genetics.

We certainly found this in our work where there was real appetite to understand the funding flowing into the area from public sector, residents, the community, and local business and to consider how best this could be invested in the wellbeing of residents. We didn’t get as far as to model if the area was receiving the funding that its needs demonstrate and/or indeed to recommend a % of the area budget to go into something like Participative. Budgeting (PB) as they do in parts of Scotland,…….here’s where we would need the support of someone like C.Co. to help us with and the sums behind PB

So lots of people are interested in place based working and indeed some LAs have appointed Place Directors but usually this is to differentiate their work from a bunch of folk called People Directors who largely focus on children’s and adult social care services but actually they both have resources at their disposal which will provide wellbeing outcomes. In our work we spent some time talking to Place colleagues working on town centre masterplanning or large regeneration schemes to look at the flexibilities they have to do things differently. From this small sample of folk it would seem the issue is more about Place people seeing the potential to link with People people rather than prescribed process and do’s and don’ts .

So why blog, well because this is interesting and because it feels like the right thing to do and therefore we should recommend this approach. We would however, want to pursue this approach in partnership with providers such as C.Co who ‘get-it’ and who can add value to the process. We can offer a review, policy development inc financial modelling (via C.Co) participative budgeting and all the documentation to put in front of decision-makers.


NHS Procurement Consultation Requirements and Brexit

I guess procurement colleagues are excited/appalled in equal measure regarding the implications of BREXIT on procurement practice. But that aside (and I know that’s a big ask) I’m interested in the relationship between procurement policy guidance and consultation best practice.

If we agree that at very least procurement policy is ‘up in the air’ as we contemplate abandoning EU treaty law, general principles of contract law will surely remain: equality of treatment, transparency, mutual recognition and proportionality.

So what does this mean for consultation and engagement? Are procurement and consultation separate processes or can they overlap? Could this even be desirable/good practice? Andy Mills blog pic

On a recent A&G contract for a CSU, NHS England’s Programme Assurance Team required evidence of “deliverability (of the service change) on the ground and affordability in capital and revenue terms“. The CSU proposed that market engagement could provide such evidence and that this activity should run in parallel with public consultation. Whilst I think this is possible it’s not ideal as one process runs the risk of affecting the other. What do others think?

In the meantime I know tCI are considering recruiting procurement specialists to their associate team in order to provide clients with advice in this important area.

This blog was originally published by The Consultation Institute 


Its a curious thing…

I’ve started this blog a few times as I reflected on a recent piece of engagement work for a public health department within a Local Authority. The curiosity I was considering was how a discipline steeped in issues such as inequalities could find the principle of engaging with people who use services, stakeholders, residents so difficult to execute. But perhaps it’s not so surprising coming, as they have , from the NHS where Commissioners were drawn kicking and screaming into meaningful engagement and consultation processes. By the way as if further proof of this I’ve just looked through the presentations to a local CCG ‘patient engagement event’…..and disappointed to see they are still pushing PPGs as the primary way to get involved in their decision-making process when there is so much good practice going on elsewhere myhealth

Perhaps the gap between theory and practice should have been filled by engagement professionals with a toolbox of evidence based approaches and practical tips to make it easy for commissioners. Actually I think much of the time they/we make it harder not easier. Talking to commissioners sometimes remind me of holidays in France when I’d spend ages preparing my schoolboy French to go and ask for something at the campsite shop and despite thinking I’d perfected the pronunciation I remained unintelligible until I drew a picture.

My reference point is simple; public services should be run based on the principle of as much public involvement as possible. Tax payers have a right to have a say and decision-making is better when it’s based on user experience. The commissioning cycle provides a framework to consider this;

Commissioning/engagement cycle

In the Local Authority I’m working in we have used this framework to plan for the engagement of young people at each stage

Activity Detail Action Timeline
Needs Assessment/Option Appraisal Consult via focus groups and surveys to establish the needs of the local community in regard to sexual health services.Target Groups:

  • Young people who are cared for and care leavers.
  • Young people with special educational needs or disability.


Andy Mills to provide discussion guidelines.Young Advisors to assist in facilitating consultation depending on availability.


TCS to facilitate consultation with cared for young people and care leavers.

10th October 2014
Procurement Evaluation Panels to meet to consider tenders Develop process to involve YA in scoring of tenders (interview process) Mid November
Mobilisation and Contract Management Service Users to provide o-going mechanism to ensure service meeting needs of clients Use techniques such as ;Mystery shopping to test experiences of services users Mobilisation from Jan 15, contract goes live July
Review See above

With thanks to Laura Goodfellow at the Children’s Society

If the comments above were about the ‘carrot’, then there’s a ‘stick’ too. Here are some areas where decision-making by public bodies has been challenged on the basis of poor public engagement or consultation. Known as the Gunning or Sedley principles after case-law from 1985, ‘consultations’ should be at a time when proposals are still at a formative stage, sufficient information should be provided to enable intelligent consideration and an intelligent response. Adequate time should be given for this purpose and the product of the consultation should be taken into account during decision-making.

So we can wait until the judicial process compels public health to engage with people who use their services, stakeholders and residents or we can take a moment to consider how to do so meaningfully before we re-commissioning substance misuse, smoking cessation, weight management, school health, health visiting services etc


Local Authorities took responsibility for a range of public health activity as a result of the Health and Social Care Act 2013. Many contracts which were subject to novation to Local Authorities have not been subjected to market testing for many years (if ever). Local Authority CEOs and elected members have therefore required this process to be undertaken within a 2-3 year window (we are now in year 2)

organisations with expertise and capacity should consider offering support to public health departments often lacking these skills in order to design and implement meaningful engagement at all stages of the commissioning cycle.

>>> Patient power in the NHS

Hi all, again haven’t blogged for a while……but I’ve been working on this paper with OPM.

It highlights how patient power can be used to transform all levels of the health service – from shaping policy and system reforms, effecting service delivery changes, to transforming the dynamic between patients and their healthcare providers.

In it we draw on OPM’s own experiences, as well as good practice examples from a recent OPM-hosted seminar, and consider how the health service can put the needs and wants of patients at the heart of everything it does through effective patient and public involvement.

Shared Decision Making – the response of a whole health economy

Hi all haven’t blogged for a while… here’s one we made earlier. I wrote this with Ewan King from the Office for Public Management (OPM)….not sure if he’s published it yet?

Presented increasingly as the way care should be delivered – not least in the NHS England CCG Assurance Framework and the National Patients in Control Programme, Shared Decision Making’s (SDM) time has come. Defined as ‘an approach where clinicians and patients make decisions together using the best available evidence’ (Elwyn et a BMJ 2010), SDM can be associated with a narrow set of skills and tools (in particular patient decision aids [PDAs]) used by doctors with patients rather than something that requires the whole NHS system response.

It is however, increasingly accepted that in order for wider system reform goals such as integrated /pathway commissioning or commissioning for outcomes, SDM provides a valuable framework to work within. SDM is now being seen as an integral part of a treatment pathway stretching from primary care through acute and back into the community.

It was exciting therefore to have the opportunity this week to speak about shared decision making to senior health system reform leaders – senior GPs, leaders of the CCG, acute sector managers, a regional NHS England representative and those from the Academic Health Science Network and the local Medical School – from a single local health economy – Wirral.

Wirral has been at the forefront of patient engagement and patient involvement for some years – and many of its local hospitals and GP practices are seen as innovative leaders. This group of senior leaders were brought together by a local GP with an interest in SDM. Our presentation covered findings from recent Wirral –based research we have conducted on SDM (in the sponsoring GP s practice), and nationally for Health Foundation: our slides are attached.

The discussion was fascinating and moved from initial scepticism and challenge into broad acceptance of the principles and that more could and should be done to promote SDM in clinical interventions. But perhaps more importantly the group reflected on how SDM should feature much more in pathway design as clinicians need to share clinical decisions across disciplines and with service providers from the voluntary and community organisations and patients themselves. For instance, there was a lively debate about how the growing tide of patients – sometimes needlessly – being referred into secondary care could be stemmed somewhat by the introduction of intermediary expert advisors who would see patients referred into secondary care before they see a consultant to explain the full range of options available to them, including less expensive community based options that might prove just as effective.

One suggestion was that there needed to be ‘expert intermediaries’ between the GP making the referral into secondary care and consultants who are often have little time to fully explore care options with the patient. At the moment, the argument was made, too many patients arrive to see a consultant having been referred their GP without a good understanding of what the alternatives are to surgical (and often very expensive) care options.

The discussion went on long into the evening and were greatly supported by academic and Med school colleagues  one of whom had undertaken a study tour on SDM at a renowned US treatment centre which fully embraces SDM as a critical part of the patients planned recovery.

The barriers to system implementation are however myriad and complex: the lack of consultant and GP time to fully embrace SDM; the capacity of some patients to consider complex information or too much information; the lack of focus in commissioned contracts on SDM; and the difficulty of layering SDM into complex care pathways. 

The lack of evidence to inspire doctors to adopt SDM was also a hurdle: ‘Is there any evidence that this will save money, and if so, in which areas, for what conditions, and over what time period.’

There was immense potential in some of the ideas that were discussed to overcome these hurdles. We hope to do some further work on exploring potential for SDM in the Wirral and will keep you posted.

OPM are hosting a seminar: Realising the power of patients to produce tangible and radical reforms: Moving from the possible to the essential in the new NHS on the 27 of March


What do CCGs do…more importantly what do you do…..?

I was talking to a colleague who works for a CCG recently and who was asking me to come and talk to some of her GPs in their protected learning time, about substance misuse service re-design. I said I had been working with the Commissioning Managers at the CCG and was assured that substance misuse was a priority (well alcohol misuse was anyway). My friend said ‘ yes but you still need to talk to the GPs ‘cos they won’t all agree with the CCG commissioners’. Now one of the things I could see the sense of in the new landscape was the boiling down structures into a straightforward connection between patients and commissioner via the GPs. Common sense then suggests that commissioning decisions about lots of patient care is done collectively hence a CCG.

However, in reality it may be a really big ask for GP commissioners to balance what they feel needs to be commissioned, informed by day-to-day contact with patients, with conflicting guidance from NHS England on policy or indeed evidence base. I just wonder if the latest guidance on patient and public involvement trans-part-hc-guid1 will resonate in a CCG under pressure from its own members to deliver improved patient care?

On a connected matter I mentioned the above conversation to my mate Dave who is building my website at the moment and he said ‘well never mind what does a CCG do, i don’t understand what you do…….’ I suppose that’s a downside to the AMP business model, its difficult to sound flexible and adaptive without appearing a bit shifty and vague. My concern about this problem has been compounded by the need to express myself more on my webpages…..I actually find it a bit difficult talking about what I do. Whilst in public service ( I like that term) I was extremely proud to work within the NHS, although not delivering care I was a Manager doing the stuff that difficult to explain to people outside of public service. Things like needs assessments, evidence reviews, commissioning plans, service designs, performance reviews, governance audits.

Now i’m a civilian or even more alarmingly a private sector provider I need to be clearer about what I do because the customer needs to know what they are buying. So……

…..’I’m Andy Mills, I work for AMP who provide user insight, qualitative research and consultancy services to private, public and voluntary sectors’

How’s that?