When Your Doctor Prescribes Friendship, Not Pills

With non-medical factors driving 80%[1] of health outcomes, SingHealth Community Hospitals is leading a global revolution in healthcare - where healing starts in the community, not the clinic.

When 88-year-old Mdm Foo Siew Yin was admitted to Sengkang Community Hospital for rehabilitation after a fall, she appeared depressed and withdrawn, reluctant to engage with her recovery process.

This caught the attention of Ms Amy Chan[2], a Wellbeing Coordinator (WBC) whose role represents a key innovation in healthcare delivery, Mdm Foo’s journey took a different turn. Unlike traditional clinical staff, Ms Chan is a non-medical professional specially trained in Social Prescribing. When she noticed Mdm Foo's depressed state, she actively engaged Mdm Foo and was able to connect with her over time, discovering her likes and dislikes. Through personal and motivational conversations, Ms Chan identified community programmes that matched Mdm Foo's interests and needs.

The transformation was remarkable. Ms Chan connected Mdm Foo with volunteer Ms May Hung through the Outreach and Volunteers team. From being reluctant to leave their home, Mdm Foo and her sister began regularly attending weekly rhythmic exercises at the Seniors Activity Centre and engaging in community activities. This personalised approach demonstrates how non-medical interventions can significantly impact patient wellbeing, creating sustainable connections that extend well beyond hospital discharge.

This case exemplifies the groundbreaking work of SingHealth Community Hospitals (SCH), which was designated as the world's first World Health Organization (WHO) Collaborating Centre for Social Prescribing in November 2024. This recognition comes after SCH became the first hospital worldwide to implement social prescribing in a community hospital setting in 2019.

Social prescribing was first pioneered in the UK by Dr Michael Dixon and Dr Sir Sam Everington, who observed that approximately one-quarter of primary care consultations stemmed from social rather than medical needs. Their groundbreaking insight revealed that issues like loneliness, financial difficulties, and housing problems were driving many healthcare visits; challenges that medicine alone could not resolve.

Building on this foundation, SCH has thoughtfully adapted the UK model to Singapore's unique healthcare landscape. "Social determinants of health, which include living conditions, social connections, and access to support services, can account for up to 80 per cent of health outcomes, while medical care contributes only about 20 per cent," explains Associate Professor Kheng Hock Lee, Deputy CEO (Academic Medicine and Partnerships), SCH.

Innovating for Singapore's Context

SCH's adaptation of social prescribing has several distinctive elements. Unlike the UK's primary care-focused approach, SCH pioneered implementation within a community hospital setting, creating a new pathway for patients transitioning from acute care back to the community.

The WBC role, as exemplified by professionals like Ms Amy Chan, breaks from traditional healthcare delivery through SCH's deliberate choice to staff this crucial position with non-medical professionals. This innovative approach recognises that connecting patients with community resources requires a different skill set than clinical care. WBCs bring diverse backgrounds in life experiences, community work, and advocacy, allowing them to focus entirely on understanding patients' wellbeing and building strong community connections.

Since 2019, SCH has screened over 3,000 patients, connecting suitable patients with essential community resources. The programme's success demonstrates how non-medical interventions can significantly impact patient wellbeing, creating sustainable connections that extend well beyond hospital discharge. However, as Assoc Prof Lee notes, "The most difficult part of a personalised care plan is in the implementation. WBCs often have to journey with the patients to close the last mile."

Social prescribing has since expanded beyond SCH to across the SingHealth Regional Health System to benefit more patients. To date, SingHealth has about 100 WBCs across different settings, from hospitals to the community.

Shaping Singapore's Healthcare Future

The initiative is especially timely given Singapore's demographic trajectory, with nearly one in four Singaporeans projected to be 65 or older by 2030. Older people are more likely to be hospitalised and require longer stays or experience multiple readmissions due to complex medical problems and co-morbidities.

"As social prescribing becomes more integrated into our healthcare system and national initiatives like Healthier SG and Age Well SG, more patients can benefit from this care model," says Assoc Prof Lee. "More widespread social prescribing can include scenarios such as a patient with diabetes being prescribed a cooking class to learn healthy eating habits, or elderly patients attending tai chi or digital literacy classes to keep mentally and physically active."

Building Community Partnerships

Underpinning the success of social prescribing is collaboration across sectors. SCH has developed partnerships with ministries, government agencies, grassroots organisations, and voluntary welfare organisations to create a comprehensive network of community resources. "Such collaborations enable us to tap into a rich network of community-based programmes that promote holistic wellbeing across a range of community resources, including arts and culture, sports and physical activities, nature and green spaces, and lifelong learning," explains Assoc Prof Lee.

 Healthy, Empowered and Active Living Labs

Building on the strong foundation of multi-disciplinary collaboration, SingHealth launched another innovative initiative in 2024: the Healthy, Empowered and Active Living (HEAL) Labs. Led by SingHealth Centre for Population Health Research and Implementation (CPHRI), these living laboratories serve as testing grounds for community-centric interventions to meet the needs of Singapore's ageing population.

The first two HEAL Labs, established in Bedok and Marine Parade, have already shown promising results in addressing senior-centric challenges. Currently, these labs support the Community Ageing in Place Ecosystem (CAPE) Programme—a signature SingHealth population health initiative that tackles the declining old-age support ratio through an integrated approach that combines social and healthcare services, built environment modifications, and targeted technological solutions. A comprehensive baseline study spanning Bedok, Marine Parade, Bukit Merah, Tiong Bahru and Telok Blangah has already profiled over 1,600 seniors, and is working towards a target of 1,840 by September 2025.

The study's initial findings revealed crucial gaps in community support and healthcare access. This led to collaborative co-design workshops that brought together stakeholders from government agencies, academia, healthcare, and the community that produced 36 community-centred solutions aligned with the WHO Age-Friendly Cities Framework. Practical implementation strategies have also been drawn up over the next three to five years.

Professor Chien Earn Lee, Deputy Group CEO (Regional Health System), SingHealth, emphasises the significance of this approach: "SingHealth's HEAL Labs have been instrumental in enabling us to pilot interventions that can be tested and scaled up quickly for implementation. By synergising our HEAL Labs' innovative solutions with strategic community partnerships, we want to bridge gaps that affect the health of seniors while taking into consideration their unique personal needs and aspirations. In doing so, we hope to enable our residents to live and age well in their communities."

With these successes, a third HEAL Lab opened in Redhill in August 2025, featuring the IMPRESS-MIND2S (IMPlementation stRategiEs for Scalability and Sustainability- Multidomain INterventions in a structured care pathway to Detect and Delay cognitive decline in community-dwelling older adults) programme which aims to detect and delay cognitive decline among community-dwelling seniors. This structured care model integrates personalised coaching, cognitive training, physical activity and social engagement, supported by senior-friendly technology like SilverPads, which offers cognitive stimulating activities to promote digital inclusion and telehealth service adoption.

The combination of social prescribing model, HEAL Labs, and CAPE represents a transformative shift in healthcare delivery that recognises community-based innovation and stakeholder co-creation as essential components in promoting health and wellbeing beyond traditional hospital boundaries.

Looking Ahead

Plans to expand HEAL Labs are in the works, with SingHealth aiming to launch at least three more within the next three years to address priority population health challenges that our community face.

As healthcare systems worldwide grapple with ageing populations and rising chronic disease burdens, SingHealth's social prescribing model represents a fundamental shift in how we approach healthcare delivery. By successfully integrating social and clinical care, SCH has demonstrated a sustainable path forward for Singapore's healthcare system.

As a WHO Collaborating Centre, SCH advances social prescribing practices globally in key areas such as capacity building through workshops and training, collaboration to develop and update training content, as well as research to contribute to regional and global evidence building for the impact of social prescribing. Social prescribing is set to become even more integrated into mainstream healthcare systems, with technology playing a crucial role in accelerating its growth as a mainstream model of care.

[1] Return to Wellness with Social Prescribing | SingHealth

[2] Social Determinants of Health Data Quality at Different Levels of Geographic Detail - PubMed