What has social prescribing got to do with palliative care?

Social prescribing describes a way to link people to community services that can support their health and wellbeing. In this sense, it is similar to the broad array of community-based palliative care and day hospice services that offer social connections and wellbeing activities throughout the UK.

The origins and development of social prescribing as a concept within UK health and social care settings mean that most UK social prescribing focuses on supporting people with mental health problems or long-term conditions. I want to talk about why this might be the case, and if there could be any opportunity to strengthen collaboration between social prescribing initiatives and palliative care to benefit patients and families, and support policy makers and palliative care providers.

Helping social prescribing and palliative care services work together more closely could help make them more inclusive, make it easier to describe our services, and measure their impact.

Social prescribing can be described as connecting people to activities that improve their health and wellbeing. The social prescribing process can look different depending on the setting, involving healthcare or self-referral, but it always takes a person-centred approach, linking medical referral to community organisations. These can offer activities such as social spaces, art and gardening. 

While this sounds very much aligned with palliative care - which aims to provide holistic care at end of life both clinically and in community settings - social prescribing to date has predominantly focused on mental health and long-term stable conditions.

Social prescribing services are growing, both in the UK and globally. These services also align with the NHS’ 10 Year Health Plan, which looks to expand neighbourhood support. The NHS now has prioritised funding for dedicated social prescribers for primary care networks across the UK. There is good justification for this. There is increasing evidence on the physical and mental health benefits of social prescribing in the UK. Social prescribing has been linked to reducing healthcare costs and research suggests it is cost-effective for the NHS. 

Like other multi-component interventions that support wellbeing, assessing the impact of social prescribing was initially seen as a challenge. However, there is a growing body of resources and frameworks to make this possible. Social prescribing has also started being recorded in large datasets such the English Longitudinal Study of Ageing. This could allow us to monitor how it impacts people later down the line.

There is even evidence on the benefits of social prescribing in conditions related to palliative care, such as moderate dementia patients and careers. These studies indicated social prescribing can improve mood and social connectivity in carers and improve patient care experiences.

In contrast to the flurry of health policy interest seen in social prescribing, palliative care day hospice and outpatient services are increasingly under financial strain. Understandably, this often leads to a tendency to focus on a medicalised health-centred approach, even though service users value social and wellbeing support (1).

One reason for this is the challenges demonstrating their impact – a recent National Audit Office report highlighted a disconnect between hospice activity and how this is communicated between providers and policymakers. While we may be well aware of the benefits service users obtain from wellbeing services, there are difficulties measuring and evaluating the cost effectiveness of such services, which may put them at risk. 

Palliative care services frequently offer a large range of activities for people affected by incurable illness, their carers, and bereaved carers. This can include an eclectic mix of activities to meet the needs of our service users – anything from chair yoga and crafts, to bingo and bee keeping, but also practical advice and support, such as Citizen’s Advice clinics. These initiatives can be accessed through differing pathways but can include specialist, GP and self-referral. Surely this could extend to social prescribers, working together to reach isolated individuals who may have limited support networks?

Surprisingly, the concept of social prescribing is seldom used in research literature for palliative care in UK adults. We initially planned to review this literature. We combined established terms and phrases relating to  social prescribing and palliative care to search across six academic databases but did not find enough literature to warrant a review. This is despite the fact that palliative care includes many activities that could be made available by social prescribing. We find this particularly surprising for two reasons: 1) the track record hospices have for providing high quality holistic services and 2) the policy importance of social prescribing within the NHS.

The striking disconnect between palliative social wellbeing services and social prescribing is somewhat intriguing. Could it reflect a lack of consistent terminology that has impeded collaboration between services, providers and commissioners?

Let’s consider the health prevention focus of social prescribing – it aims to help people self-manage to live well for longer, lending itself well to preventing physical and mental health conditions. Yet that shouldn’t exclude palliative care. We know quality of life remains as important at any stage of life. Furthermore, supporting wellbeing can have lasting consequences on the health and prosperity of a person’s family. 

The growing awareness of the importance of compassionate communities brings another perspective. This reframes death and dying as part of society, as it is a life event that impacts everyone around us. This centres around providing support in communities, throughout all life stages, to be better prepared to manage death. Compassionate communities seek to de-medicalise and move away from medical terminology. Terms like ‘prescribing’ imply the patient being passive and a narrative of ‘being done to’, which is discordant from community and relationship building.

However, social prescribing also seeks to harness the medical - health and wellbeing benefit - of community assets. It seems that despite the possibility for collaborations between compassionate communities and social prescribing these differing narratives may account for the lack of alignment so far. 

This raises a question: what is the most suitable terminology to describe the diverse range of holistic wellbeing activities our services provide for people requiring palliative care, and for those who matter to them? How can we communicate the health and wellbeing benefits of these services to health policymakers, while also acknowledging that their holistic nature extends beyond physical support and can look very different in different contexts?

Social prescribing could also be a way to extend the reach of palliative care services, to the most vulnerable and underserved in our society. Indeed, we see it cited in the NHS strategy to reduce inequalities and there is evidence to support this. Analysis of administrative datasets suggest social prescribing through non-medical routes supports uptake by minoritized groups and can reach highly economically deprived groups. Nevertheless, a link between reducing health inequalities and social prescribing has been brought under question and very few social prescribing initiatives have attempted to measure equity and inclusion (2).

It is crucial that rather than consider social prescribing as a “quick fix”, inclusivity should be considered with respect to the target population and not assumed. For end of life services to be equitable, they must consider participatory ways to consider different world views and share decision-making power in order to break down cultural barriers – as was well articulated in a recent opinion piece (3). Social prescribing initiatives at the end of life could have the potential to connect to communities and reach underserved populations, but this will only be possible with consideration of their cultural values and working with existing community and faith groups. 

With increasing funding pressures across the health and social care system, there is scope for hospices to better articulate and collaborate in their wellbeing service delivery, and for commissioners and policymakers to actively include such services in their social prescribing provision. The UK has seen growing investment in services and workforce for social prescribing; it remains core to the NHS 10-year plan which seeks to move from hospital to community care and neighbourhood health. The tools, terminology and evidence gathering processes developed for social prescribing could aid evidence-based decision making, to better articulate existing holistic palliative care support and foster greater collaboration and inclusivity.

Collaboration between social prescribing and palliative care could improve both 1) service delivery and 2) evaluation and measurement of impact. 

1. Terjung, T., Stiel, S., Schneider, N. & Herbst, F. A. Status, demand and practice models of palliative day-care clinics and day hospices: a scoping review. BMJ Support Palliat Care 14, e235–e249 (2024).
2. Sonke, J. et al. Social prescribing outcomes: a mapping review of the evidence from 13 countries to identify key common outcomes. Front. Med. 10, (2023).
3. Hussain, J. A., Vijayshankar, R. & Hodgson, M. End-of-life care needs cultural humility and social justice. BMJ 391, r2598 (2025).

This piece was written by Dr Chloe Tuck, who is a researcher based at the Wilkes Institute, St Luke’s Hospice who is passionate about equity and inclusion in palliative care. She builds on cross-sector experience in health communications, global health charities and her PhD research which used creative methods to explore cancer experiences in Ghana and relate this to policy.

The piece was inspired by the St Luke's Hospice social prescribing hub and came about through extensive discussions, a literature review, and insights from the wider St Luke’s Team, in particular Sam Kyeremeteng (Medical Director and Trustee at Hospice UK), Zoe Manders (Social Worker) and Paul Taylor (Head of Research).