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In this blog, Health Services Researcher, Debra Westlake, from the Centre for Evidence-Based Medicine, explores her previous role investigating social prescribing at the University of Plymouth, Community and Primary Care Research Group where she was working as a Researcher in Residence for a health system in the southwest of England.

Profile picture of researcher, Debra Westlake.

Debra Westlake is a Health Services Researcher at the Centre for Evidence Based Medicine.

Embedded researchers are co-located within the NHS or other service settings. Evidence is created in partnership (or is ‘co-produced’) by researchers, practitioners and people who use services. The aim of the method is to work alongside colleagues in services to implement evidence-based practice in continuous cycles of learning in which  ‘knowledge’ is not regarded as a privileged commodity of academia but something that is built together (Marshall 2014, Gradinger 2019, Vindrola, 2017). For researchers it is about climbing down from our ivory tower and getting our hands dirty.

But what does this mean when, due to a global pandemic, the only ‘co-locating’ is with your adult offspring sent home from University, and the ‘embedding’ is in a bedroom? 

It would have been hard to predict this turn of events when accepting a post as Researcher in Residence on the evaluation of social prescribing at the end of 2019. I was employed by Plymouth University, but my ‘residence’ was within a Sustainability and Transformation Partnership (STP) (now an Integrated Care System or ICS). For the first six weeks of 2020 I was homed in County Hall in a vast shared office. Despite the expressed aim of encouraging integration, the space uneasily combined hot desking for Health, Social Care and Local Authority commissioners; zones were demarcated by separate coffee, tea and biscuit cupboards and distinct lanyards. In early March 2020, meetings about social prescribing began to be cancelled. I overheard huddled commissioner conversations over back-of-the-envelope sketches of algorithms about infection and isolation guidance. On the final day I went into the office, there were perhaps five of us (all Health) in a sea of over 100 empty desks.

I carried on being a Researcher in Residence for 18 months after the cycle of lockdowns began – but in my own residence. As an outsider, it was challenging to be accepted in virtual meeting spaces with busy managers and practitioners facing the huge challenges of COVID working. However, fledgling relationships, built face to face before the first lockdown, with strategic leads in social prescribing and with projects across the large footprint of the ICS, proved invaluable to my involvement. I was able to continue collecting participant observer data at naturally-occurring events such as online meetings, peer support groups and conversations between and with staff.  

The start of lockdown was a confusing and difficult time for everyone attempting to deliver services. Social prescribing aims to tackle the social determinants of ill health by connecting people to activities (‘prescriptions’) in their local community to improve their wellbeing. How could social prescribing happen when no one could leave their home and with the mass shutdown of community groups and activities? Was it even important to do that when avoiding infection was a priority? But then isolation, anxiety and economic hardship began to emerge as key social impacts of the pandemic. As it turned out social prescribing was needed more than ever.

Many of the social prescribers (or link workers) at the frontline were, like me, new in post. Like me they were figuring out how to ‘embed’ themselves within a new setting and attempting to build relationships and work closely with colleagues they hardly knew, while managing home life, child care and often with no work-from-home tools. This common experience was bonding. It generated a sense of reciprocal working between researcher and practitioner which proved invaluable to developing genuine relationships.

It occurred to my project team at the time (DESSPER) that this was a valuable real world experiment in adaptation and implementation. We worked with our supportive and flexible research commissioners in the STP to rapidly repurpose our original evaluation questions so we could investigate the COVID impact on social prescribing. My role became that of a listener, critical friend and supporter alongside academic researcher. Social prescribing has been described as being about connecting people to local resources. I did my own connecting work by linking up social prescribing projects across our county, so they could compare practice and learn from each other’s extraordinary adaptations to COVID, as well as give each other peer support in the face of huge challenges. In return, practitioners generously allowed me to accompany them on this journey and to be a witness to this unprecedented time.

The research team collected data (mostly qualitative observations and field notes) where it was available and not intrusive to do so and reported its absence where it was not. We summarised data for projects so it was useful for reporting and co-produced analysis of impacts for strategic decision makers and project managers. Importantly, we were able to conduct a rapid online survey of social prescribers to inform NHS England about what was needed. Barriers to social prescribing delivery during the early pandemic included a lack of basic equipment such as mobile phones and laptops as well as variable access to electronic primary care patient records systems. Regular peer support, management and supervision meetings were crucially important to support this new role in primary care settings. As a result of this feedback, central funding was released to remove some of these barriers.

The most important and humbling comment on impact came from one of the project leaders:

“Debra’s approach has meant we have felt empowered as a team to action the analysis ourselves, with the confidence of knowing the support/guidance has been there as needed – Debra has also offered us the opportunity of reflection at each stage of the process to ask any questions, offer her input/expertise (e.g. with the draft preliminary framework) and keep us on track. Debra has 

also been able to link us into various forums, resources and conferences that we would have otherwise most likely not known about, due to her overarching knowledge of initiatives in the area – the links have been hugely beneficial for networking and the ongoing development of our project and coaches. We are hugely grateful for her time and input.”

We are currently writing up our results for publication, but for me the key impact has been in knowing that I was not in a privileged position collecting data, but was part of the data and supporting the response under COVID with sleeves rolled up and microphone unmuted.

Debra Westlake currently works at the Centre for Evidence Based Medicine, on a National Institute for Health Research funded study of social prescribing link worker implementation. In the NHS in England, primary care has received funding to employ link workers. How the link worker role is set up and carried out varies across the country, and it is evolving in response to contextual changes such as the COVID-19 pandemic. Through the research we will develop an in-depth understanding of the link worker role; this will enable us to generate evidence-based recommendations on how to optimise its delivery in primary care. You can read more about this study here