Enabling Social Prescribing

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Research Findings Report

Introduction

This document brings together key findings from research looking at barriers and potential mitigating strategies, and tooling or data standard refinements to the

@OpenActive⁠

standard to position it as a data standard inside the broad Social Prescribing eco-system. The work was commissioned by the Open Data Institute who are the custodians of the

@OpenActive⁠

data standard on behalf of

Sport England⁠

Digital Gaps Ltd⁠

, supported by

Porism Ltd⁠

, were commissioned to deliver the work between Mid-January and Mid-March 2021.

Healthier Pennine Lancashire⁠

provided engagement with managers and frontline workers for the research.

A summary of the research steps is given in section 3 at the end of this document. All the research material is available through Coda and instructions as to how to use this are given in the last section of the research section.

Key Findings and Recommendations

The hypothesis or vision is that

@OpenActive⁠

as an Open Data standard can become a key part of the Social Prescribing eco-system to underpin increased referrals into physical activity. The opportunity to realise this vision will rely upon a broad range of factors, some of which are within and others outside the direct influence of

ODI⁠

. The following section summarises the key findings under three headings:

Cultural and Process key barriers and opportunities

Standards and Tooling barriers and opportunities

Wider considerations.

1 Cultural & Process Barriers and Opportunities

Over the following pages, the main cultural and process barriers are summarised under three main headings. These are barriers from a cultural perspective that are holding back the adoption of Open Data generally and that specifically affect the opportunity for

@OpenActive⁠

to play a role in the Social Prescribing eco-system. The opportunities and recommendations are a set of potential actions that ODI can take forward to mitigate or overcome those barriers. These cultural barriers are outside ODI’s direct influence, but are important to recognise as they will play a critical role in influencing success against the overall objective.

1.1 OpenActive is one example within a wider Open Data Public Sector Strategy

⁠

@OpenActive⁠

is playing a growing role within the sport and leisure sphere. Over the next 5 years, adoption of Open Data generally will inevitably increase; OpenActive will benefit in terms of take-up as this broad trend continues.

Social Prescribing is a high-profile initiative. It is a busy marketplace with a number of national initiatives and an increasing number of private sector suppliers targeting the area with software, training and consultancy offers. It is inevitable that Open Data will become part of Social Prescribing, perhaps not quickly, but certainly over time. It is less inevitable that OpenActive will become part of this eco-system as a stand-alone data standard.

Whilst continuing to promote adoption into the sport and leisure world, positioning OpenActive into the hectic and highly fragmented Social Prescribing market may benefit from some of the following potential approaches that seek to align and embed OpenActive within a broader Open Data strategy.

Recommendations

1.1a Open Data must be a simple message; there is a need to align Open Referral UK and OpenActive

Social Prescribing is a highly fragmented set of processes. For example

There are 1,250 Primary Care Networks nationally. Most of the decisions and leadership about the process, the culture and the behaviour of Social Prescribers are taken at PCN level (or sometimes taken down at General Practice practice level. There are on average 3 or 4 GP practices per PCN)

Within any PCN area, there will be in excess of 100 hyper-local service offers that have value to a Social Prescribing process, that will cut across activity and non-activity-based community offers. For these to be a referral option for a Social Prescriber, they all need to adopt a format that allows them to be visible / searchable within the chosen technology product for that Social Prescriber team.

There will continue to be growth in the numbers of technology suppliers that enter the marketplace (for example Social Care software providers who may decide to develop a Social Prescribing module)

In a local area, the delivery of an Open Data enabled set of Social Prescribing processes will need alignment across the five identified stakeholder types, namely: the frontline worker, the managers, the activity provider, the activity application provider, and the frontline worker software provider.

Where these stakeholders are faced by options about adoption of either

@Open Referral UK⁠

(an open data standard adopted by the UK to make referrals into support services) or

@OpenActive⁠

, this may create confusion. In the high-pressured and fragmented world in which they work, stakeholders may choose one data standard; the other; neither; or may choose both. There will certainly be significant private sector and local influence that will be pushing un-structured data capture of the information (use my system because…..) and a reliance on Google searches.

People do not like change, and are often worried where there is technical change. To enable change to happen, the message about adoption of Open Data must be a simple one; an approach that seeks to promote one data standard, increases the risk is that people will choose to maintain the status quo and hence both data standards will continue to be adopted very slowly. There is therefore a need to align

@OpenActive⁠

and

@Open Referral UK⁠

so that the choice is simply the adoption of Open Data rather than choosing one standard or the other. The technical recommendations in section two of this report detail the options for how to create this alignment.

1.1b Help create cross-sector National Open Data Leadership and Governance

As the custodian of

@OpenActive⁠

, the

ODI⁠

, alongside

Sport England⁠

, should play a role within the national governance and national leadership of the strategy to promote Open Data adoption. To take this forward, ODI and Sport England would benefit from aligning with the

Open Community - MCHLG⁠

and ensuring that the Government Lead on Open Data, Sam Roberts, is brought into the discussion on bringing together that Governance. Cross-sector leadership and governance is needed to:

manage standards, such as taxonomies, that apply to many sectors;

manage the evolution of standards with overlapping roles

create business case templates and case studies to help drive adoption of Open Data.

Without this national cross-sector governance, each individual agency will adopt their own data standard or policy related to overlapping considerations. The result will leave duplicated sets of data across these sectors, will hamper the market for innovation (because tools will only be able to work with a smaller set of data) and thus undermine the very core of the business case for Open Data in the first place.

For example, the following are all considerations that will need to be resolved, where single joined-up governance will underpin the cross-sector business case for Open Data

Defining where to capture and how to define intensity levels.

@MCRactive⁠

have set out to define their approach. Inevitably other active and other social prescribing partnerships will be defining their own solutions. Providers will then have to map their offers to each of the differing approaches, which will create the risk that they elect one, the other or neither option

Having a standard related to safeguarding checks.

@MCRactive⁠

have defined their approach and

@ActiveWestminster⁠

have defined theirs. Where an organisation delivers services in both localities they will be checked through different models. As other localities develop their own approaches, so the numbers of checks will increase and hence frustration and confusion for providers, who may decide that the level of checking and bureaucracy is too much of a barrier

Having standards related to accessibility of venues and also services - again without co-ordination, the options will create confusion, frustration and undermine the speed of adoption.

⁠

Porism⁠

and

Digital Gaps⁠

can facilitate some introductions to help move this forward.

1.1c Champion the message that Social Prescribing is a wider concept, rather than solely a GP-led referral mechanism

Social Prescribing is firmly set within the NHS domain. The summary discussion paper on

Numbers and Measures⁠

offers some insight into the broader set of similar local referral processes that are also about social prescription in their nature.

London sport⁠

in their research have recognised this broader range of referral mechanisms.

The amendments to the data standards that are recommended, all recognise this broader social prescribing role. It is recommended that

ODI⁠

look to position Open Data and

@OpenActive⁠

as having a key role across this broader set of community referral processes. This increases the scale of activities / services to which the data standard can be applied; in theory this makes the business case more attractive for the following two reasons

Firstly, the volume of applicable processes increases

Secondly, much of the change consideration is no more effort, because many of the stakeholders, like the third sector, the broader activity providers, councils,

@PCNs⁠

@CCGs⁠

are the same across all of these pathways.

It is recommended that ODI and

Sport England⁠

, potentially also in partnership with Open Community, consider funding a number of small pilots to develop the key headline business case messages for how Open Data supports these wider examples.

For example, Mental health as a pathway is an area where increased exercise is known to be beneficial. Working with a community Mental Health provider and a council in one small area would allow a pathway or use-case to be defined to ensure that anyone who does not meet the threshold for support from a Community Mental health Team is connected into a range of low-level informal, “social prescribing-ready” exercise groups locally to where they live. What is also worthy of note is that MH providers themselves often deliver their own internal activity sessions that should be defined using Open Data and opened for wider referral pathways potentially.

Creative Support is a walking football service in Pennine Lancashire that is delivered by qualified Mental Health professionals. They would be willing to support a piece of work to estimate the volume of potential referrals, capture and manage the additional sets of information that are identified in the data and tooling recommendations and run a pilot to evaluate the impacts across this critical pathway. Similarly, through the interviews, a Social worker from within the CMHT in Hammersmith and Fulham also expressed an interest to consider a similar piece of work.

The other area of potential opportunity is to align the health-based assessment initiative across Lancashire where there is a push to contact employers to offer assessments to their employees. This could be an excellent opportunity to ask people to monitor their personal health indicators (like VO2 Max, some blood tests (like HbA1C test for risk of diabetes), weight etc) and monitor the impact of their choices on their health over 12-24 months. Throughout the programme, examples of relevant Open Data activities could be made available to people to monitor whether tracking their personal health, alongside access to potential Open Data defined local activities drives increased take up and better outcomes. This type of in-depth and considered measurement will be of significant interest and value to the new Office of Health Promotion and addresses some of the issues considered in the report on measurements.

1.2 Silo-based Digital strategies at a Local Level

Adoption of Open Data needs more focused co-ordination and leadership locally. Adoption is guilty of a narrow, silo-based approach where councils have their own ambitions, evidenced through the MHCLG Digital Declaration and local NHS, police and fire service have their own broadly un-aligned strategies. Progress locally is limited, against these broad ambitions; similarly the strategic Open Data ambitions of

@DCMS⁠

and

NHSX⁠

, and perhaps Sport England are not matched in terms of local implementation.

Without stronger local leadership, the silo-nature will prevail, and progress will continue to be slow, where the detail relies on real joined-up implementation, robust plans to deliver the necessary promotion to internal partners and to local activity providers, and accountability to focus on the real efficiency benefits.

Successful adoption of Open Data relies on co-ordination of what happens cross-sector at a local level. It is perhaps not helpful to define “local” too prescriptively, as this will differ depending on local leadership behaviours and a range of factors. However, there are a range of actions and messages that ODI and Open Data Leaders should be championing into local stakeholders. These messages should focus on the benefits to those local partners, namely councils, NHS organisations (mainly Primary Care –

@CCGs⁠

historically have tended to be more focused on Acute Hospital issues and hence wherever possible the focus should be on the

@PCNs⁠

), Sport and Leisure, the police, Housing, the third sector etc.

The messages and actions must focus on the benefits to stakeholders, most importantly access to accurate information and secondly the efficiency from capturing and maintaining information once only. The wider benefit is then the increased take up of access to local community activity and service offers. Adoption of Open Data per se has little direct impact; it is what it enables that is the benefit. The following recommendations set out some potential actions options for how to help champion the right messages and to help shift the digital dial to mature.

Recommendations

1.2a Procurement

It is recognised that one of the issues for the success of

OpenActive⁠

is that it requires an ecosystem where there is supply and demand. This is not always easy to put in place (see working as a place below). However, the public sector can use procurement to promote compliance to open standards. Currently the public sector is not doing enough to provide an infrastructure that complies with OpenActive data standards. One reason for this is the lack of a real understanding of the benefits of open data (see Open data working as a place below) and so any compliance is treated as a ‘ticking the box’ exercise rather than seeking to gain the benefits.

The lack of use of procurement and funding/grant power effectively makes the task of creating the ecosystem very difficult. It takes time and money for existing applications and processes to take advantage of the open data standard.

The NHS is currently considering what can be done to scale Social Prescribing. The HSSF procurement framework is likely to insist on Social Prescribing applications integrating with

Open Referral⁠

and

OpenActive Feeds/APIs⁠

. Also note that they will ask for other details which may be different to other sectors and so put a burden on activity providers - see Cross Sector and Place Governance above)

We recommend that the ODI, perhaps with the cross-sector and place governance team, work with Crown Commercial Services to document appropriate paragraphs that can be included into relevant specifications. Where these procurement frameworks are used, this will ensure that only software providers that are compliant with OpenActive and other open data standards are procured.

1.2b Funding / commissioning

The above recommendation is to embed the

OpenActive⁠

and other Open Data standards into procurement specifications. At the same time, the ODI, alongside the Cross Sector Open Data Working party, should also approach the Sport (non-Government Bodies) and the key national third sector funding bodies, such as National Lottery. They should be requested / ordered to mandate that wherever funding is awarded, then the definition of the activity must adhere to

OpenActive⁠

. In addition, the organisations that are funded should be signposted to the Local Councils, who it is recommended should be at the forefront of promoting Open Data across their place.

Furthermore, to help tighten adherence to the

MHCLG Digital Declaration⁠

, funding should be prioritised at areas that signed up to this commitment. This might be something to discuss with

Open Community - MCHLG⁠

. Ideally, this would go a step further and require some evidence of the progress that councils have made in progressing their declarations. Progress will always be slow, but the customer deserves the right to access more accurate data and the system should focus on the wider efficiency impacts.

The above paragraphs target national funding organisations. The local public sector also commission significant local third sector delivery; there is also therefore a mirror piece of work for Local Councils; where they are commissioning a local activity or service, the council should mandate that the provider must define their service offers using Open Data and must capture this information through a local portal. This will dovetail with messages that come nationally from the national third sector funders.

1.2c Blueprint

We recommend that the

ODI⁠

work alongside a pilot local area to develop a “blueprint” that will set out a model and a headline plan with supporting tools and guidance on how to implement an OpenActive / Open Data ecosystem to realise the benefits across a place. This should include ‘understanding the benefits of open data’ for managers and workers and ensuring they have the right applications, skills and equipment.

The best examples identified through the research are perhaps

@MCRactive⁠

@ActiveWestminster⁠

and

London Sport⁠

. The opportunity exists to unpick what they have achieved and re-build the templates and the key decisions they have taken. The interface to Social Prescribing exists as an ambition and plan in both Westminster and MCRactive; as they start to plan the detail of the implementation it may be beneficial to capture the live learning through that process, which will provide a very valuable set of materials for others to learn from and adopt. Similarly, across Pennine Lancashire, there is an opportunity to “testing” how these materials are put into practice as they follow behind with the plans related to their Local Delivery Pilot, called Together an Active Future.

1.2d Place-based example business case

One of the challenges to Open Data adoption is that the business case only stacks up when it is widely adopted across a place. There could be as many as 15 local referral pathways (Social Prescribing being one example) that may benefit from access to accurate information about local community-based sports, activities and groups.

If all 15 pathways adopt their own data standard and define this separately then the reality is that there will be no business case. The benefit that the demand-side (Social Prescribers and other local referral pathways) are seeking is an easier process to secure reliably accurate data. The benefit that the suppliers are seeking is aggregation of demand (all of the pathways together), which creates visibility of all demand for them and hence increased opportunity for take up, alongside an efficiency where they can capture information once for all of the pathways (rather than describing separately for each separate pathway).

It is important to recognise that Open Data can be as inaccurate as non-structured data. The messages should focus on delivering accurate data, which happens to be open data; rather than just promoting Open Data as the message. The messages should focus on the efficiency and accuracy benefits of collecting the information once and being able to use it numerous times. It is these messages that will engage local leaders to move the agenda forward, rather than focusing on the technical message.

1.2e Aggregating demand and the value of aligned taxonomies

The adoption of Open Data needs demand to drive it. An interesting example to consider is the development of the market for ordering home-delivery take-away food, which has grown from nothing in a decade to a frightening scale. This has been driven by demand.

Similarly, it is the aggregation of demand for local activity and services by bringing together the range of community social prescribing into a single process and a single platform that is key. A single process that brings together demand across third sector providers, social prescribing link workers, Mental Health prescribing, Self-care prescribing, District nurse social prescribing, allied health professional social prescribing, community policing social prescribing, Adult social care prescribing, early help children’s social care social prescribing and school-based social prescribing will drive the demand that will ensure that local activity providers make their offers available in whatever data standard is requested.

It is recommended that ODI work with a local area to drive this example case study. It is absolutely critical that this process includes a focus on taxonomy and searching functionality. The estimate is that there may be in excess of 5,000 locally based activities and social groups in a population of approximately 200,000 people. There needs to be comprehensive search tools to search this list; without it, each search will return many dozens and sometimes hundreds of options, which is unusable. This aggregated search process will also require the ability for nurses, GPs, school professionals and MH professionals as well as police for example to be able to search for relevant services and activities using language, lists and choices that mean something to them. It is also not feasible to ask the provider to map separately to each of these different taxonomies, as they will need to become an expert in the differing taxonomies used by these sectors.

There is a need therefore for an overarching set of taxonomies that sit “at the centre”. Each agency can then map their own terms to the central list, use their terms to search and at the same time, the provider only needs to map their offer to one set of terms. Further details are included in section 2.2d Taxonomies across sectors of this document and in the technical review document.

The recommendation is for representatives from NHS, LGA, Police, Fire and the third sector to bring together an initial set of these common taxonomies and test the success. Across Healthier Lancashire and South Cumbria ICS and within Pennine Lancashire, the tools and capability exists to consider this pilot.

1.2f Working as a Place (creating the eco-system)

Our research has identified that five main stakeholders are involved in the end-to-end process to surface activities through OpenActive open data. (See

stakeholders⁠

in the

Research Steps⁠

). It is the aggregation of supply and demand that is key. There is little point an activity provider loading up their session data if there is no frontline worker looking for appropriate activities for their service user (using software that is

OpenActive⁠

compliant). Equally there is no point a social prescriber looking for a local session near to their client’s address (close to home to save time or to save money on transport) to find that there are very few suitable activities available (because no-one is entering their session information).

⁠

Manchester Active⁠

Westminster Active⁠

and

London Sport⁠

all seem to be progressing with a place-based ecosystem approach. They are generally a single sector implementation i.e. Leisure but with links to Councils and

@CCGs⁠

. The ideal solution would be if this could be implemented by the 42 new

@Integrated Care Systems⁠

which are cross-sector by nature. These may be too large an area and it may be that starting with an

@ICP⁠

and scaling across ICPs to become an

@ICS⁠

might be a more pragmatic approach.

A place-based ecosystem will need to prepare the stakeholders:

The implementation will depend on managers at various levels and in different organisations. They will need to be on board with the benefits of open data; a half-hearted, tick box approach will frustrate stakeholders and deliver no impact

Frontline Workers will need to be confident that they have the means to identify suitable sessions

Application Provider software will need to be compliant with OpenActive

Activity Providers will need to have a means to easily maintain their session data.

Our research interviewed managers involved in Social Prescribing and found a mix of views, approaches and frustrations. Some understood the benefits of open data but didn’t believe that it would ever reach critical mass. Some did not understand open data but were happy to comply as long as it didn’t detract from their day job. Our interview of

@SPLW⁠

s identified a lack of training in this area and lack of digital devices.

The recommendation is that there is a need for this technical place-based understanding that identifies the key messages and benefits for different stakeholder groups.

1.2g Adopt a holistic approach (Activity referral by stealth), aligned to health conditions and use the language of pathways

It is recommended that the

ODI⁠

looks to identify some strong examples or case studies of holistic approaches where exercise classes / sessions (that are defined using

@OpenActive⁠

) can be combined alongside other non-exercise related recommendations to help drive good health outcomes (that are defined either an aligned Open Data standard, such as

Open Referral UK⁠

). The development of these holistic solutions should be led through small cross-sector pilots, where they can consider key target cohorts and define and pilot simple sets of recommendations (such as attending a social walking group, attending a healthy eating workshop and joining an online (without their video ‘on’ – as being seen on camera often puts people off) stretching class to music for example.

This holistic approach is recommended for four reasons

Firstly, the belief is that the strongest evidence for good health outcomes is where exercise forms part of a wider set of behavioural changes. There is a good evidence base for the benefit of exercise on certain conditions (like Mental Health for example), but creating a holistic set of recommendations allows exercise to be combined within a broader set of support, that may soften the “take exercise” message that some people may be unwilling to consider / hear

Secondly, it will soften the hard sell required to some Social Prescribers who may remain ardently against motivating people to take up exercise. All Social Prescribers will be able to sell the beneficial set of combined recommendations that includes exercise, thus more readily persuading

@SPLW⁠

to play this role in helping increase referral to take up activity

Thirdly, it is certainly true that many of the patients being supported by link workers provide an infertile ground for driving take up of activity, as they seem to be anxious about treating / addressing current crises / worries. They are unlikely to respond to the direct message to “take up exercise”, but may respond to the message that there is a specific pathway designed for people with their reported concerns which consists of a range of steps which would include the housing or benefit advice for example that may be important for that cohort, as well as some exercise as well

Finally, this is also an easier sell to the 1,250

@PCNs⁠

. Health has a very academic approach to evaluation and evidence and a broader focus on doing groups and trying to persuade people that exercise is the answer may be a tougher sale than selling a vision that there are identified pathways that work well together to balance exercise with diet and social activities.

One manager commented that the focus should be on getting people moving in whatever activity they are interested in e.g. Gardening can get people exercising without them noticing, rather than getting them to do physical activity. Gardening does seem to be on the OpenActive activity list but it seems on its own as a broader physical activity (

@Playwaze⁠

did comment that they would like a broader activity list). This re-enforces also the need for alignment of

@OA⁠

and

@ORUK⁠

(See Technical Issues section below).

For information

Digital Gaps⁠

is looking to start working with two GP practices, namely Norwood surgery in Southport and Central Waltham Forest in London with a very simple example of using a pathway mapping to physical activity in the pre-diabetic context.

2 Standards & Tooling Key Issues & Recommendations

This section provides the conclusions formed by

Digital Gaps⁠

and

Porism⁠

in carrying out the user and technical research with some recommendations to ODI.  In many ways this represents the real heart of the work. There is a separate

Technical Review⁠

document but this section attempts to summarise for a less technical audience.

There are two keys barriers that are being addressed here:

Firstly, looking to create a clearer delineation between the core public sector-funded infrastructure and the opportunity for innovators to deliver into the resulting market.  At the same time, the public-sector funded infrastructure must help deliver a more transparent and more attractive market that entices more innovation

Secondly, recommending some additional fields within the standard and some additional tooling to help all stakeholders ensure they are adhering to and benefitting from adoption of the standard.

2.1 Clearer delineation of commercial opportunities through open definition of standards

Means to access the data: API v Feed

The biggest technical barrier to application providers looking to consume OpenActive data is the perceived complexity and cost in consuming the data from

@RPDE⁠

feeds. Better explanation of why RPDE is used to publish data and support and guidance in reading from RPDE could minimise this issue.

The more familiar model sought be many developers is a standard

@REST API⁠

. However REST APIs can place a heavy load on publisher servers and increase the risk of Distributed Denial of Service (

@DDOS⁠

) attacks - in other words crashing the publisher’s system. The technical review report summarises means of limiting the demand on publisher servers.

For an ecosystem to flourish from OpenActive data both ease of publishing and ease of data consumption are needed. It is anticipated that some publishers may choose to implement standard

@REST API⁠

s as well as or instead of

@RPDE⁠

feeds to widen access to their data. There is also an opportunity for use of converters from RPDE feeds to standard API outputs.

Application developers will benefit from a ‘

standard⁠

’ API knowing they can invest in products that consume data from any standard compliant feed without needing to go through a two stage process of reading and interpreting feeds before performing a data query.

As the market for Social Prescribing software grows, the demand for a standard and easily understood means of reading OpenActive data will grow.

Recommendations

2.1a Develop a REST API

It is recommended that ODI improve the guidance and support for using an

@RPDE⁠

feed and develop a basic

@REST API⁠

standard for accessing

@Session Series⁠

data.

RPDE documentation should explain the rationale behind using RPDE so developers can assess its benefits alongside a more traditional API approach.

APIs are better understood by data consumers and it is anticipated that there will be a market for developing Feed to API products.

The existence of a basic standard for APIs will help developers prototype interfaces and allow for easier switching between social prescriber and other software products that consume activity data.

Non-governmental bodies may be expected to subsidise the development of products that target their sports via filtered data feeds where the market needs some stimulation.

More details are given in the technical requirements document

here⁠

2.1b OA and OR convertors

Comparing OpenActive & Open Referral⁠

⁠

The alignment of

@OpenActive⁠

with

@Open Referral UK⁠

has been mentioned by a number of research stakeholders. Physical activity is a subset of the services and activities that a

@SPLW⁠

will be likely to make referrals into. Based on the types of people currently being supported, their emotional readiness for a discussion about activity and the increasing focus on

@SPLW⁠

throughput, it is inevitable that referral into physical activity will always be marginal compared to the wider set of support services sought.

It is obvious that an alignment between the two standards needs to be made clear to all interested parties and this is referenced as part of the Cultural/Process issues within this document. Application providers, subject to there being a return on any investment, would be happy to implement integration with

@ORUK⁠

and

@OA⁠

, whichever the local commissioner requests. The technical review focused on whether it would be possible for the two data standards to co-exist and provide converters between formats. 

2.1c Consider the option for OR to consume OA

It is possible to convert both ways but each would have fields missing. See

@Converting data to and from OA and OR⁠

. One of the options is for Open Referral to consume OpenActive which would deliver a more rounded solution, rather than using convertors both ways. It is recommended to trial some of the conversions to be consumed by Open Referral service finders.

In trialling this option,

ODI⁠

should engage with the custodians of Open Referral UK to explore the mutual benefits and the way forward. The big picture is that the two data standards will be stronger together, rather than a focus on their relative position which may result in a decision to “compete” and leave data consumers, activity providers and software providers (both activity / service finders and activity application providers) confused and ultimately having to choose (one, the other or both).

2.2 Enhancing the standard and the tools to address the reasonable requirements of Social Prescribing

The following recommendations identify the changes to the data standard and the tooling to maximise the impact that the OpenActive standard will have in supporting Social Prescribers to access local activity opportunities.

Recommendations

2.2a Data richness and quality 

The

@SPLW⁠

needs to be confident that the data is up to date. There is a modified date included in the feed but this should be brought into the data set so it can be consumed by the activity finder (or the social prescribing software) and can provide that confidence and evidence that the information is up to date.

Additionally, there is a recommended new field to show an assurance date (this is about assurance of the data, rather than assurance of the activity provided, which is covered below) so that an activity provider can confirm that their data is up to date and has been assured. Data assurance wasn’t always an issue for

@SPLW⁠

during the interviews, mainly perhaps as they tend to check manually (phone call / email for example) that all information is correct themselves. However, as productivity in social prescribing becomes more of an issue, data assurance may become a concern and an opportunity.

The research has identified a set of fields that will be helpful to Social Prescribers, offering additional information to their clients about the activity, the expectations and even some example pictures or videos for example. These detailed requirements can be viewed in

Coda here - Social Prescribing Data Requirements.⁠

⁠

We have labelled these as

@SP Ready⁠

fields indicating that these are the fields that would indicate that an activity can meet the additional expectations that will help someone who may be apprehensive, gain a better understanding of the activity.

However, having data attributes in the data standard will not guarantee that it will be populated.  Essentially this is down to the Activity Provider but if they want to reach an

@SPLW⁠

audience then they will make the effort and some tooling could help. Using the SP ready fields as a profile then a completeness checker would review the data entered and return messages to the provider, alerting them to any missing fields or attributes.

Obviously not everyone will be concerned about meeting Social Prescribing needs so it is recommended that there is another tool for the frontend (in the activity finder or social prescribers software tool) that would check the richness of the data and allow a

@SPLW⁠

the option to filter out activities that do not meet these SP requirements. This then removes the risk of viewing multiple activity offers that don’t offer the key support that they are seeking for their clients (

@Facilitator type⁠

for example). This will improve the experience for the end-user and retain their trust and faith in the process and the Open data.

A further issue raised by the research was that often descriptions and definitions don’t offer the real understanding of a potential activity option. “A picture paints a thousand words”; the recommendation is that including the necessary fields and standards for photos to be uploaded may drive increased confidence, understanding & trust, and could also reduce the ‘anxiety of the unknown’ to

@SPLW⁠

clients who have never attended this particular activity. 

The

Technical Review⁠

document and the

Data Requirements⁠

document include the proposed fields. In discussions with providers their response was always very positive; if there is additional information that they can make available to aggregate demand and increase potential referrals then they are keen to adopt them. Similarly the feedback from potential clients was also supportive, that example photographs, for example, would be beneficial.

In moving these forward, there may be value in some practical trials to test the value of including the additional fields to ensure that in reality Social Prescribers do find the information valuable in practice. The trials should also ensure that providers feel the additional effort is worthwhile. The work being undertaken by

London sport⁠

will start to offer some insight into these areas, but they may need to be longer and more robust trials, where the timeframes for London Sport are very short. The success or otherwise will be driven by demand and with COVID still restricting attendance this evidence will not be available.

2.2b Activity & Provider Quality Assurance

A key concern raised by some social prescribers and by some managers is the desire to have evidence of quality assurance of both the activity and the provider. This was an underlying concern for most Social Prescribers through the interview and most wanted to actually visit and experience something before they would ever make a referral. It is recommended that there are additional fields included that allow quality marks or quality assurance to be captured against activities and providers. The details are included in the technical document.

Quest (

https://questnbs.org/active-communities/introduction-to-active-communities⁠

) is an example of a Service quality kitemark that would give assurance of safe-guarding or other policy requirements. This is supported by Sport England but we do not know how useful that would be to

@SPLW⁠

nor do we know the burden impact on the activity provider. It is noted that

@MCRactive⁠

will be carrying out their own provider checks but it is not yet known how they will communicate this to

@SPLW⁠

Establishing the trust of the activity provider should not create an insurmountable barrier to very small activity providers and it should always be a case by case risk based decision as to whether a

@SPLW⁠

client wishes to attend a session hosted by a provider. It could be the provider is the client’s local church and in this instance it may well be that the need for a kitemark is not considered necessary.

Currently

@SPLW⁠

tend to either check out the activity and provider themselves or many commented that they would accept a recommendation from a trusted colleague. Consideration has been given to some form of tooling to allow an SPLW to ‘look up’ a professional review of an activity or provider.

The technical review recommends attributes similar to

@Open Referral UK⁠

so that any kitemark can be added by the activity provider and verified by the

@SPLW⁠

It is recommended to carry out further understanding of

@Quest Quality standard⁠

and

@MCRactive⁠

or other similar kitemark systems to understand whether they might be a solution to the assurance of an activity provider. 

It is also recommended to encourage innovators to provide a professional rating of

@OpenActive⁠

activities/providers i.e. a form of Trust Pilot for professionals in order to encourage

@SPLW⁠

to be more confident in making referrals.

2.2c Booking

The feedback generally was that the ability to make a live booking was not deemed important by

@SPLW⁠

. Over a series of meetings between a Link Worker and a client, it is easy to envisage that search, discover and book may happen over a prolonged set of discussions and over a number of weeks. As long as there is clear information about how to book, then the ability to be able to book live, rather than for example to email to reserve a place is perhaps not critical.

However for two reasons, it is recommended that further research as follows is required to consider the value of booking

Firstly, the concerns from managers about productivity, across not just Pennine Lancashire, indicate that the ability to book may become more important. The views of some local and national leaders for Social Prescribing should be consulted on whether this is important

Secondly, and more importantly, the wider use-case for Open Data should include the opportunities for self-prescribing, self-care and self-finding. This constitutes far higher volume of referrals and is likely to be characterised by a higher expectation and requirement for live bookings. In other words, those people who perhaps have a 40 year-old health assessment and are made aware that they are in the bottom quartile for their health in relationship to risk of Cardio-vascular disease for example. A simple activity finder, with some simple questions about their preferences, may quickly identify available sessions; this cohort is more likely to want to book there and then. An opportunity to test this use case should be considered, targeting perhaps a high-profile activity such as gym access. There is a very large affinity gym-booking programme that may offer an interesting case study to establish demand.

2.2d Taxonomies across sectors

⁠

@OpenActive⁠

is making use of three taxonomies. It has a robust

@Activity type⁠

taxonomy, which works well for someone who knows what they want to book, but is difficult for someone to identify the types of activities that they may be interested in e.g. indoor low intensity sports. This issue is addressed in the Culture & Process Issues in this document.

There is a

@Concepts⁠

taxonomy which is not fully established which attempts to link activity to certain conditions. Thirdly, there is an

@Accessibility list⁠

taxonomy which is currently being developed so that activities can indicate how accessible they are either based on the level of assistance provided or based upon some adjustments that can be made to accommodate specific needs.  

These taxonomies have to be understood by activity providers and be a minimal burden on data entry. However, the bigger issue here is that

@SPLW⁠

have to use

@SNOMED⁠

codes which means there needs to be a mapping of

Taxonomies⁠

to the three taxonomies so that appropriate activities can be extracted from the data. This is also an issue for

@Open Referral UK⁠

. The conclusions from the research is that central cross-sector taxonomies are required to protect the activity (and service) providers from too many ‘mapping to category’ demands from the various sectors. See diagram and explanation in the

Technical Review⁠

It is recommended, therefore, to carry out a short piece of co-production work with

Pennine Lancashire⁠

to create some broader terms to group the activity-types.

It is also recommended to consider the Cultural/Process recommendations on cross sector Governance to support the adoption of an accessibility taxonomy and a simple conditions taxonomy rather than developing something specific solely to OpenActive.

Related to this work, the opportunity for a small set of central cross-sector taxonomies should also be explored with this governance. The risk to the broadest Open data strategy, is that a lack of alignment across sectors with regards to taxonomies will entirely undermine the core business case for open data through resulting in the following

Inaccurate data entry where providers have to understand different taxonomies across multiple sectors

Inaccurate searching by social prescribers where the mapping of one set of terms to another is inaccurate.

3 Further Considerations

This section provides some wider observations for consideration. These are not recommendations, but offer wider comments on the Social Prescribing market which may help

ODI⁠

in their deliberations about how to best approach the opportunity to position

@OpenActive⁠

within the Social Prescribing eco-system.

⁠

@SP⁠

is a small, fragmented service area

Social Prescribing remains an immature, highly fragmented and potentially volatile programme.

Decisions and processes tend to be defined at a PCN level, with additional influence by individual GP practices. Influencing change across this breadth of stakeholders and local leaders will be highly complex.

In the last 12 months, there have been perhaps 1,000 new Social Prescribers recruited nationally, almost all on short-term contracts who will all different background, views and experiences. It is a high profile programme right now; although

@PCNs⁠

can make decisions from April 2022 to move away from

@SPLW⁠

model should they wish. Estimates are that 30% of the GP practices are likely to move away from using them.

⁠

@SP⁠

is only a small part of the referring community

As identified already in this report and the

Numbers and Measures⁠

discussion paper, the number of people within the

@SPLW⁠

pathway who will become sustainably physically active just because there is better information available to a SPLW is always going to be fairly low. It certainly will be helpful and does remove a barrier. It will also create a positive experience for patients who will be able to consider a hyper-local list of possible activities; this may help them view the entire

@SPLW⁠

process in a better light and hence increase their motivation.

There is however an opportunity to consider the widest scale of community-based social prescribing that happens. The total scale is probably ten-times the volume of pure GP-triggered social prescribing case-loads alone. People in the core

@SPLW⁠

pathway are probably fairly complex and other referral pathways may provide a richer vein for exercise referrals, including family and friend and self-care considerations.

Measuring the outcome of a SPLW-referred interventions in an unscientific way is without value

The research evidenced a broad range of measurement and management information is currently collected, but without clarity about how or why this is used. There is an opportunity firstly to streamline / slim this down. Thereafter, where there is a real interest and the right resource to evidence the value of certain activities on improving outcomes, this should be subject to the right statistical and scientific control.

The core function of

@SPLW⁠

is making links and connections into community services; measurement of success of the SPLW process / service should focus on that objective. There is an increasing sense that the “system” is seeking evaluation of the Social Prescribing model, which could become a massive programme lasting several years to provide longitudinal evidence.

In terms of improved health outcomes, the approach might be better targeted at individuals who measure their own sense of well-being for their own consideration to inform their own plans and decisions about the impact of changing their behaviour. The information currently is targeted at measuring the “system” and hence disengages citizens. Exercise on referral is widely considered as failed model, which is arguably a key driver behind the Local Delivery Pilots,

https://www.sportengland.org/campaigns-and-our-work/local-delivery⁠

; ownership of behaviour change is the key to sustainability, not externally-driven evaluation. There are opportunities to pilot whether individuals are motivated where they set their own goals and measure their own progress, rather than being measurement being “done to them” by the state.

Cultural and Language barriers

It was recognised by most interviewees that there are cultural and language barriers to successfully engaging people into activities or services that are significant. Across Pennine Lancashire, as part of the Together an Active Future programme, they have adopted a strategy to use cultural and faith group leaders to lead many of the messages into those communities. This creates the legitimacy that can help drive take up of physical activity. There are increasing examples of ever-improving translation widgets; there remain further opportunities to improve tooling for this capability, with a particular need to focus on Easy-read and perhaps more importantly a trigger than knows that the source data has changed, to ensure all translations are updated accordingly.

Adoption of OpenActive is not a complex technical consideration

The

@OpenActive⁠

standards and tooling is actually reasonably good. Yes there are improvements that can be made and indeed we have made some suggestions but generally OpenActive is fit for purpose. The reason why this has not taken off is because success depends on an ecosystem with supply and demand and that is difficult to establish across different sectors and stakeholders.

There isn’t a business case

There is no financial business case for adopting OpenActive solely to try to increase referrals into exercise through GP-referred Social Prescribing. There are changes required across technical, cultural, commercial and behavioural processes within arguably all five of the identified stakeholders (

Stakeholder Analysis⁠

). The level of investment to drive these changes and the risk / noise of competing priorities and messages, where the focus is solely on Social Prescribing, does not stack up.

There is a business case for place-based adoption of Open Data, but not for the individual components of the ecosystem. There are two key elements, namely

Alignment of OpenActive and Open Referral UK, so that this is about all local service offers, both activity-based and community group-based

Aggregation of demand across all referral pathways, so that it is not just about Social Prescribing, but encompasses self-care and a wide range of other community referral processes.

This business case is realised at a “place” level where demand can be aggregated to drive adoption across stakeholders.

Application providers are commercial

The same message was given by all the application providers we spoke to. There must be a commercial reason for any investment. Generally they will provide whatever the paying customer would like. They are not put off by the complexities of implementing an open data standard and would implement whatever was either demanded through procurement or if they thought it would increase their chance of generating income. As above it is aggregating demand that will deliver that commercial case for all.

Clear on opportunities for innovation

The ODI need to be clear what will be provided as the standard and what is left to innovate within the market. Greater transparency of this will not only drive innovation, but will also lay bare where additional incentives are required to further enhance the broadest model.

Open Data as a national infrastructure

The UK nationally needs to take Open Data more seriously and treat it as a digital infrastructure. It is perhaps not as obviously required as broadband but if this does not become the fabric of our digital services then the UK will miss out on the benefits of joining up disparate information.

View the

Research Steps⁠

Download the PDF version

⁠

Research Findings Report.pdf

303 kB

⁠

Introduction

Key Findings and Recommendations

1 Cultural & Process Barriers and Opportunities

1.2 Silo-based Digital strategies at a Local Level

2 Standards & Tooling Key Issues & Recommendations

2.2 Enhancing the standard and the tools to address the reasonable requirements of Social Prescribing

3 Further Considerations

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