Social prescribing: Placing community at the heart of healthcare
Adeline Kwan from SingHealth Community Hospitals (SCH) shares the importance of considering a person's social context in medical treatment, and SCH has successfully brought social prescribing into the Singapore healthcare system.
Imagine you meet two patients. They are the same age, have the same illness and were diagnosed at the same time. They receive equivalent medical treatment—but while one recovers quickly, the other suffers a relapse. Why?
"Their social determinants of health (SDOH) are different," shared Ms Adeline Kwan, Assistant Director, Office of Community Engagement and Education (OCEAN), SingHealth Community Hospitals (SCH). It could be that one patient lived with his family who could remind him to take medication and accompany him to check-ups. The other lived alone, rarely left the house, and often forgot to take his medication and missed check-ups.
OCEAN's key project is to address these non-medical factors—such as education, socioeconomic status and social support—that affect up to 80 per cent of a person's health outcomes.
To do this, the SCH team, with support from management and clinicians from different disciplines introduced a person-centred care model called social prescribing to its patients. Started in the UK, this is the process of connecting people to resources such as interest groups or support providers within their communities, with the aim of addressing their SDOH.
Bringing social prescribing to Singapore
Upon admission into SCH, patients are screened for SDOH risk-factors and those who require support are enrolled into the programme. Throughout their stay, they are engaged in wellness activities such as gardening, exercising, singing and reading. Prior to discharge, they are connected with community groups that can continue to support them when they return home.
Ms Kwan elaborated: "If the patient's social support system is weak, then we need to make sure they have relationships in the community. We'll talk to them, find out what they enjoy, and connect them to those resources so that when they go home, they have something to look forward to when they wake up each day."
The 2019 pilot at Bright Vision Community Hospital was well received: Of the 94 patients referred to Wellbeing Coordinators—non-medical staff who connect patients with community resources—86 joined the inpatient social prescribing programme. Over 20 per cent were successfully linked to community assets such as Senior Activity Centres and other drop-in centres with social activities. Patients reported improvements in quality of life and were less likely to be re-admitted into hospitals.
As of 2023, the social prescribing programme has expanded to Sengkang Community Hospital and Outram Community Hospital, and the team of Wellbeing Coordinators has grown from one to 12.
For their efforts, the OCEAN team received the Best Team Award (Patient Experience Improvement Category) in the SingHealth Quality Service Awards 2023.
An agile method of working
Ms Kwan likens the programme's success to "introducing McDonald's". Although the team referenced case studies from overseas, they did not "import the whole menu". "We had to adapt and localise it for our target audience, like how McDonald's introduced the Lychee Oolong McFlurry," she quipped.
For example, social prescribing is mostly introduced at the primary care level overseas. Instead of following suit, the SCH team decided to introduce it in the inpatient setting, as its hospitals were already used to running patient engagement activities and could easily sync them up with the new programme.
They also did not wait until the model was "perfect" before launching it, but worked iteratively, improving it step by step: They started with just one Wellbeing Coordinator, to see if having a dedicated member of staff to get to know patients would be able to provide clinicians with a more holistic view of each patient's needs.
When that worked, the team was gradually expanded. Eventually, when the programme was more established, and the OCEAN Team understood the skills gaps they needed to close, they set up the SCH Office of Learning to conduct formal training programmes to grow their talent pool and share the knowledge and expertise of social prescribing with the community care sector.
Building the social prescribing ecosystem
This saw the team work with SkillsFuture Singapore and Ngee Ann Polytechnic, on the SGUnited Health and Social Care Coordinator course during the pandemic. Of the 43 course participants trained in two course runs, six have gone on to become Wellbeing Coordinators at SCH.
"I believe it is important for patients to remain connected, engaged and active even after discharge from the hospital, so they can remain well, and age well in the community," Caral Goh, a Wellbeing Coordinator who completed the SGUnited Skills Health and Social Coordinator course (HSCC) organised by the SCH Office of Learning in 2022 shared.
Tan Khim Chuan, who also joined SCH as a Wellbeing Coordinator after graduating from HSCC agreed. "The practicum has been especially beneficial as it provided hands-on experience with the patients as well as practical training from the professionals," Khim Chuan said.
Team OCEAN has also developed a Massive Open Online Course (MOOC) available to public on the OpenWHO platform and designed their own Workforce Skills Qualifications (WSQ) course. This allows them to maintain a pipeline of talent with knowledge of social prescribing, while building stronger connections with community organisations that participate in their courses.
Despite these accomplishments, Ms Kwan is adamant that more can be done. She noted that the concept of social prescribing has already been introduced as part of Healthier SG, a nation-wide healthcare strategy that engages general practitioners and other community providers to empower people to become healthier and improve their quality of life.
But to further drive awareness, the OCEAN team worked with Duke-NUS to create a module for their first-year medical students to shadow Wellbeing Coordinators and understand the impact of social factors on patient outcomes. They also participate in global conferences to share best practices and hosted the 1st Asia Pacific Social Prescribing Conference held in Singapore.
In addition, research needs to continue to understand the "conditions that make community referral effective," which will lead to better implementation and training.
"Expectations for medical care are changing, and patients need to be viewed as people rather than clinical pathways," Ms Kwan said. Her hope for tomorrow's medicine? "That medical care can truly sync up with social care.