Objectives Applying social prescribing to non-clinical areas such as mental health, and underlying causes including financial hardship, is essential to support integrated care across the UK health and care system. There is inconclusive evidence on effectiveness of these services with a need for more mixed-methods research to understand if and how link worker roles improve outcomes for patients in communities. Our study aimed to evaluate the impact of a Social Navigators (SN) service in South Tyneside on the health and wellbeing of users who experience financial hardship and present with complex health needs.

Design mixed methods study combing secondary analysis of service data with semi-structured interviews, conducted by peer researchers, and a Social Return On Investment analysis that matched service data with health economic indicators from the UK Social Value Bank.

Setting metropolitan borough of South Tyneside, UK (population n=151,133), ranked 3rd for employment, 13th for income, and 15th for health in term of most deprived areas out of 326 UK authorities.

Participants 330 service users who engaged with the service between 2021-23. Most users are vulnerable with two-thirds being economically inactive, the majority earning less than £10,000, and 86% suffering with one or more health issues, with mental ill health being most common (58%). Interviews with15 service users opportunistically sampled from service database.

Intervention Social Navigators working with residents who experience frequent financial hardship to identify and address underlying causes, by increasing their access to advice, health, employment and financial services, and building their skills and confidence in order to reduce health inequalities and dependency on crisis intervention.

Results Our findings demonstrate clear value for money with a £3 social return for every £1 invested in the service with a positive return confirmed in sensitivity analysis. SN were able to improve service users’ confidence, with statistically significant changes across all eight confidence-related outcomes, and helped them to access other advice and financial services. This resulted in one-off financial gains (on average £1,237) and annual financial gains (on average £1,703) for service users. The interviews identified that relieving financial burden and stress improved the quality of life for and mental wellbeing of users as a result of their involvement with the service.

Conclusions SN break the cycle of multiple visits to crisis teams by building trusting relationships and providing emotional and practical support, while being responsive to the service users’ needs. They play a key intermediary role in integrated care systems that is unique in its focus on the wider determinants of health and financial hardship, advocating for service users without time limits, and navigating the complexities of the system across local government. There is a need for better signposting and joining up of services to achieve a more whole systems approach to enhancing health & well-being in the community, while supporting the mental wellbeing of SN.

Strengths and limitations of this study

This is the first-mixed methods evaluation of social prescribing in the UK, focusing on the link between financial hardship and mental health.

Applying a mixed-methods design allowed for combing local service monitoring data with national survey data to perform a Social Return on Investment analysis.

Adding insights from service users through qualitative interviews granted the researchers insights in what outcomes mattered most to them and illuminated the mechanisms that they felt contributed to those outcomes.

Using peer researchers to collect data from service users allowed for richer data collection through existing trusted relationships, while potential bias was checked through triangulation of different data sources.

Closing gaps in local data collection, including longer-term follow-up data, and aligning data collection to national survey data would allow for more robust and less conservative SROI analysis.

Sarah Lee is Senior Welfare Support Advisor at South Tyneside Homes and involved in development and implementation of the Social Navigators service. Peter van der Graaf, Murali Subramanian and Bronia Arnott are members of NIHR PHIRST Fusion, who resourced the evaluation.

This article presents findings from independent research funded by the NIHR PHIRST (NIHR134419). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. NIHR PHIRST Fusion is a partnership between the Universities of Newcastle, Durham, Northumbria, Sunderland, Teesside, Cumbria, Sheffield, Glasgow, Edinburgh, and Queens Belfast.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was externally reviewed and approved by Northumbria University Faculty of Health and Life Sciences research ethics committee (Van der Graaf 2023-4058-4031).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

andrew2.mccarthynorthumbria.ac.uk, Murali.Perumbakkam-Subramaniannewcastle.ac.uk, bronia.arnottnewcastle.ac.uk, dilupa.samarakoonnorthumbria.ac.uk, sarah.leesouthtynesidehomes.org.uk, joanne3.graynorthumbria.ac.uk, angela.batenorthumbria.ac.uk

All data produced in the present study are available upon reasonable request to the authors