Holding, diversity and the link worker role: Reflections on a patient-public involvement meeting

A friendly welcome awaited me as I returned to the Deep End PPI group in Sheffield. It was great to see and reconnect with individuals who had been at the previous meeting I attended nearly a year ago. Ten people were at this follow-up meeting. I was returning to share with the group some emerging ideas coming from data we have collected for our study on the implementation of the link worker role in primary care. Data have come from spending time with link workers located in different parts of England, and talking to staff and patients with whom they interacted. Members of the PPI group were generous and helpful, sharing their thoughts on the topics I raised from the study data. Our discussion included a focus on the idea of link workers undertaking a ‘holding’ role, and issues related to cultural sensitivity and understanding within social prescribing.   

Holding

I described how our data suggested that link workers did not always signpost or refer people on to community resources; they often responded to and contained people’s emotional needs as they learnt about an individual’s challenging life circumstances. This was more than simply listening. It was an active strategy, that meant being present and standing alongside individuals in their difficulties. Holding, as carried out by link workers, occurred in response to:

• Lack of appropriate local provision to connect people to
• Long waiting lists for local provision that did exist
• Waiting for patients to be at a stage when they were able to try out community referrals
• The complexity of cases link workers saw; individuals often had a range of different needs with which they required support  

The group discussed how they might describe this idea of holding to other people. Thoughts they had on this included:

• Link workers showing empathy, in a space where people felt able to talk about a range of things, to open up and be vulnerable
• Link workers being transparent from the start about how they could help and the limitations of what they could do (e.g. not being able to change the local housing system); highlighting that they might not always have a solution to someone’s problem(s) but could be a consistent presence, there for the person, listening and seeking to understand things from someone’s individual perspective

It was stated during the discussion that link workers need to communicate about what is happening in terms of social prescribing – how they are engaging in this holding work – to give a true picture of what they do to others. We hope that our research will be able to contribute to this endeavour. 

Diversity

Group members were interested in the diversity of link workers and the cultural competence of these employees. They felt that a lack of such competence may mean that certain patient groups would not engage with social prescribing. This could include how the sessions were focused; individuals at the meeting noted that the idea of holding may not be acceptable to certain patient groups, if looking for a solution focused approach. We talked about training for link workers, and cultural competence training could form part of this. It was also suggested that future research could focus on this issue of the ethnicity of link workers and how this interplayed with the background of patients. 

Thank you

I would like to thank the PPI group (and Dr Kate Fryer who organises meetings) for their time and energy. Our conversation about the study has raised new thoughts and ideas about the data, which will help as we continue to undertake our analysis for the research.

The link worker study mentioned in this blog is funded by a grant from the National Institute for Health and Care Research (NIHR130247). The views expressed are those of the author and not necessarily those of the NIHR, the Department of Health and Social Care, or the author’s host institution.