Title: Community-Enhanced Social Prescribing: A non-randomised controlled mixed methods feasibility study
Funder: Department of Health and Social Care

Abstract: Background Effective social care enables people to live the lives they choose, independently and in the community, as far as possible. Local authorities duty to promote the wellbeing of all adults, including those without any current social care needs, is often discharged through working with the community and voluntary sectors to provide opportunities for people to engage with resources that facilitate social connections, promote wellbeing and reduce isolation. The current investment in social prescribing supports this and may reduce the need for formal social care services. However, social prescribing schemes are frequently too narrowly focused on individual needs; do not address community capacity; and are often not rigorously evaluated or sufficiently focused on outcomes of importance to social care. Aims This study aims to test the feasibility of Community-Enhanced Social Prescribing (CESP) in a voluntary sector agency, Bluesci, in Trafford, and to test the feasibility of evaluating its effectiveness and cost-effectiveness in a future cluster randomised controlled trial. Methods This study will use a non-randomised controlled mixed methods feasibility design. This will include three components: 1. A controlled pre-post study of individuals receiving CESP. Participants will be eligible if they have some social care needs, a low sense of community and a low mental wellbeing. 40 new referrals to Bluesci will be recruited to the study and receive CESP. This will include support to engage with community resources, enhanced by a citizens' panel which will help to increase community capacity. 40 from a neighbouring local authority (Salford) who meet the same eligibility criteria will be recruited from the community survey sample (see below) for a control group. Outcomes, including data for an economic evaluation, will be taken at baseline, 6 and 12 months. 2. Repeated cross-sectional community surveys in the intervention and control sites will evaluate change in sense of community, mental wellbeing and social care needs at the community level. A survey company will interview 246 people from the general population in each site at baseline and 24 months. 3. An embedded process evaluation using in-depth qualitative interviews and evaluation of routinely collected data will assess the feasibility of CESP for Bluesci, its staff, users, volunteers and the local community. We will interview about 50 people to explore their experience of CESP in depth, including its acceptability within Bluesci and the local community; enablers and barriers to its implementation; and identify if any adjustments to the Theory of Change model are required. Analysis The feasibility of data collection will be evaluated by calculating the proportion of missing data. Analysis of individual and community-level pre-post data will explore signals of efficacy of CESP using t-tests or non-parametric equivalents. Economic data will be analysed using cost consequences analysis and cost benefit analysis to explore the potential cost effectiveness of CESP. Qualitative interviews will be transcribed and analysed using thematic analysis. The findings will be evaluated against progression criteria to assess the feasibility of CESP in order to progress to a full evaluation in a cluster randomised controlled trial.

Lay abstract: Local authorities must promote the wellbeing of all adults including those not receiving social care. They often work with the community and voluntary sectors to support access to activities and volunteering opportunities that improve people s wellbeing and reduce social isolation. The current policy focus on social prescribing supports this and as such, has potential for reducing the need for formal social care services. In social prescribing , staff called link workers based in health settings, like GP surgeries, or voluntary organisations refer people to such activities or volunteering opportunities. However, evidence about the difference social prescribing can make to individuals and communities is limited and further research is needed to inform best practice. This research aims to look at a new model of social prescribing that we have called Community-Enhanced Social Prescribing or CESP. It builds on two approaches to working with communities we have developed - Connected Communities and Connecting People - that have been shown to improve the capacity of communities to meet local needs and have connected people better with local groups and activities. The main purpose of the research, therefore, is to see if this new model is viable, and if the difference it makes can be measured. We propose applying and testing the viability of the CESP model in one voluntary organisation, Bluesci, in Trafford ( intervention site), and using a neighbouring location as a control site. We will test methods of assessing the effectiveness and cost effectiveness of the model. This will work towards evaluating the effectiveness of CESP in a large trial involving many locations in England. Using mixed methods this study has three main parts: A before and after study of the outcomes for individuals receiving CESP and in a control group, with data collected at baseline, 6 and 12 months; Two community surveys in both intervention and control sites, conducted two years apart, to explore any change in people s sense of community, wellbeing and social care needs; A process evaluation involving in-depth qualitative interviews with Bluesci staff, users, volunteers and the local community, to find out how they experienced CESP. Analysis will explore both the feasibility of CESP and the data collection methods. The outcome and economic data will be explored for differences between the intervention and control sites. Qualitative data will be analysed thematically. Local people will be recruited to a Citizens' Panel and contribute their knowledge of the area to mapping out opportunities in community and voluntary organisations. Health and social care service users and carers from one University s community team will provide advice as members of a Lived Experience Advisory Panel and conduct qualitative interviews with individuals in part 3.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE;MENTAL HEALTH