Measuring the iceberg: The hidden impact of Social Prescribing

In the recently-published article Measuring the Iceberg: Complex Lives, Invisible Metrics, and Lived Experience in Social Prescribing, Dr Rob Dean of the University of Lincoln explores a simple but powerful idea:

When it comes to social prescribing, most of what really matters isn’t easily seen, or measured.

Social prescribing is a way for healthcare professionals to support people with non-medical issues like loneliness, stress, or financial struggles by connecting them with community services.

Social prescribing, promoted in the NHS Long Term Plan, is designed to address non-medical needs - such as loneliness or financial stress - by connecting people to community-based support.

However, Dean argues that existing evaluation approaches fail to capture the full complexity of people’s lives and the real impact of social prescribing interventions.

Based on 40 in-depth interviews with participants in Lincolnshire (2024–2025), Dean's study looks at what social prescribing actually feels like for those going through it, and what often gets missed.

About Dr Rob Dean

Dr Rob Dean is a public health researcher based at the University of Lincoln. His work focuses on social prescribing and how we understand and measure its impact. He’s particularly interested in lived experience - what people actually go through - and how that can challenge traditional ways of thinking about evidence.

Life isn’t neat and simple

One of the clearest messages from the study is that people’s lives are complicated.

Participants weren’t dealing with just one issue. Many were facing a mix of challenges at once - mental health struggles, long-term illness, financial pressure, trauma, or isolation. These things overlap and feed into each other.

That means progress isn’t straightforward. Someone might take a step forward in one area while still struggling in others. The system, however, often expects clear, measurable “improvements,” which don’t always reflect reality.

The changes you can’t easily measure

A big focus of the study is on what Dean calls the “invisible” outcomes - changes that are meaningful but difficult to quantify. These include:

• Feeling connected and less alone
• Feeling safe or supported
• Starting to trust people again
• Regaining a sense of purpose
• Gaining confidence to leave the house
• Avoiding a crisis or deterioration rather than “improving” in obvious ways

For many participants, these changes were transformative. But because they’re hard to measure and often fall outside standard metrics (like improved wellbeing scores), they’re often overlooked when judging whether social prescribing is “working.”

The power of human connection

Another key insight is the importance of relationships, especially with Social Prescribing Link Workers (SPLWs), who guide and support individuals through the social prescribing process.

 Their work involves:

• Building trust
• Providing consistent encouragement
• Helping people navigate services

Participants often described these relationships as the most important part of their experience. Link Workers didn’t just refer them to services. They listened, encouraged, and stuck with them.

This kind of support - "relational labour" - takes time and emotional effort, but it’s crucial in sustaining engagement and enabling gradual, progress over time, and making real change possible. 

Why current measures fall short

Dean argues that current approaches to measuring social prescribing are too narrow and reductionist, tending to focus on numbers - scores, outcomes, quick wins -  while overlooking:

• Slow, gradual, and sustainable personal change
• Stabilisation - preventing things from getting worse
• The importance of the building of trust and relationships that underpins success

The “iceberg” metaphor Dean uses illustrates that what is measured (visible outcomes) is only a small part of the overall impact, while deeper, more meaningful changes remain hidden.

Implications for policy and practice

The study calls for a recalibration of evaluation frameworks in public health. Specifically, it suggests:

• Recognising prevention and stabilisation as valid outcomes
• Incorporating lived experience into evidence-building
• Valuing qualitative insights alongside quantitative data

This shift would allow policymakers and practitioners to better understand the true value of social prescribing.

Conclusion

“Measuring the Iceberg” is an important reminder that real life doesn’t fit neatly into spreadsheets. It challenges dominant models of evidence and highlights the need for more inclusive, nuanced evaluation approaches.

Social prescribing can make a real difference to people's lives, but its real impact is often quiet, gradual, and deeply personal, lying largely beneath the surface - within complex lives, subtle changes, and human relationships that resist simple measurement.

And standard metrics miss this impact.

If we want to truly understand the value of social prescribing, we need to listen more closely to people’s experiences and rethink how we measure success.

Our work to 'Measure the iceberg'

To truly understand the impact of social prescribing, Dean’s “iceberg” metaphor connects closely with the It’s All About People approach to measuring what matters.

Rather than focusing only on easily counted outputs, this work emphasises asking deeper questions about the real difference services make in people’s lives and how that shapes the wider system.

Our People’s Stories approach - Community Reporters, People's Stories Template, Our Shared Agreement Listeners -  brings this to life by capturing the human impact of care - the confidence rebuilt, the crises avoided, the sense of purpose regained - “the changes that numbers alone can’t always tell.".

Insights from our People’s Story review panels further reinforce that lived experience offers vital intelligence for improving services, revealing patterns and meaning that data alone would miss.

Together, these approaches echo Dean’s central message: if we want to see the whole iceberg, we must listen to people, value their stories as evidence, and use them to shape more responsive, person-centred health and care.