Building the economic evidence case for social prescribing

Understanding the economic impact of social prescribing remains an urgent priority for the National Academy of Social Prescribing (NASP). As yet it is unclear how much data exists within the different systems to enable economic analyses of the impact of social prescribing schemes to be conducted.

The complexity in understanding the economic impact of social prescribing—and indeed all non-clinical community-based approaches to health—is compounded by the multisector nature of social prescribing. Furthermore, a variety of approaches are being used to test similar but different understandings of both cost and value, including social value, cost, benefit and economic value.

There are a growing range of reports and peer-reviewed publications that focus on the impact of social prescribing on health and social care demand, some of which have economic analyses and some which remain as potential data sets for economic analyses. At least one third of all outcomes (if not more) are directly related to the social determinants of health1,2 (SDH) which are not taken into account with economic analysis focused only on health service usage.

This range of outcomes experienced by service users2-4 is driving many researchers to conduct economic analyses that attempt to assign value to outcomes beyond the health sector, for instance using social return on investment (SROI) and proxy values. Other researchers have discussed the evolution in economic analyses at length and suggest additional components to existing methodologies, e.g., multi criteria decision analysis (MCDA) to account for additional complexity of social prescribing5. Further developments are also being trialled such as the Wellbeing-adjusted Life Years (WELLBY) to understand the economic value attached to wellbeing6, as opposed to the Quality Adjusted Life Years (QALY), which reports the economic value of quality of life.

We are entering an era of providing personalised support to people in integrated and multidisciplinary systems with different local population needs. As such, there is a need to evolve the approaches to

determining cost and value of social prescribing, and to reach agreements on methodologies that all sectors are willing to accept as sound approaches. Furthermore, as discussed by McDaid and colleagues in 2019 7, there is a need to move beyond the immediate benefits of social prescribing and to explore the longer-term benefits of sustained engagement in non-clinical activities and provision of support to address issues linked to the SDH. This would enable more data to inform the preventative role and economic impact that social prescribing may have, which is currently an evidence gap.

This rapid scoping review was commissioned by NASP and additional roundtables were supported by the National Centre for Creative Health and UKRI/AHRC’s ‘Mobilising Community Assets to Tackle Health Inequalities’ research programme (led by University College London). It aims to provide an update to the first economic evidence review from NASP and explore economic data and health and social care usage data in more detail.

This rapid scoping review aims to ascertain:

What the current literature indicates in terms of cost or value of social prescribing schemes or parts of the social prescribing scheme.

If there are potential data sets that report the impact of social prescribing on health service usage that could have economic analysis applied to them.
Stakeholder opinions on the methodological approaches for creating the current economic evaluation evidence base for social prescribing and potential future developments that are needed.

How these findings can inform a larger programme of research that is needed to establish the economic impact and value of social prescribing across all relevant sectors in the community.

As this report contains three separate elements to it, each element will be reported with methods and results, and then key themes will be brought together with recommendations.