A version of this blog was originally published on The MJ.co.uk on 8 August 2022.
There is a world in which not every person going to their doctor with a health condition—be that physical or mental—exits the surgery dosed up to the nines with medicines. And that matters. Because the root cause of their problem may be about other, non-medical, things: poor, overcrowded, and under or overheated housing; a lack of income, even if they are actually entitled to more benefits; worries about unaffordable debt; stress at work or anxiety at home; and—perhaps most important of all—loneliness. There are all these people getting the ‘wrong’ prescription, taking up the time and resources of a very stretched NHS.
To make this change happen, we need everyone to join in. We need doctors to ‘get it’ and enthusiastically embrace the case for their patients being ‘treated’ in non-medical ways. We need the charities and community groups that can provide many of the services—from mental health advice to gardening clubs, from walking football to relationship counselling—to be willing and able to play a key part. We need local authorities and other statutory bodies to be fully involved, with their advice and support services clearly signposted and delivered to those who need them. And we need patients to not feel hard done by if they are not given medicines.
What is social prescribing?
This more non-medical approach to health and well-being is very much what so many in the social and community sector have wanted for ages. We at NPC have been arguing for a bigger focus on the wider determinants of health for some years—see our Charities keep us healthy blog—and we are a founder member of the Collaboration for Wellbeing and Health. And at least some of this shift has been starting to happen via an approach termed social prescribing where people can be referred to non-medical support by their GP or other health professional.
It is not only delivering a different type of service to those in need but can be a battering ram—or at least a big nudge—to the traditional system to look at these wider determinants of health and transform the way we think about health, both inside and outside the NHS. Social prescribing borne out of locally led initiatives, often pushed by the voluntary sector, now has backing from NHS England to the extent that over 1,000 social prescribing link workers (the people who guide patients to the right support) are already NHS-funded. That is quite the change in recent years.
So, what do we need to do to make all this work? Along with National Voices—the coalition of health and social care charities in England—and on behalf and with NHS England, NPC was recently involved in a series of roundtables with leaders from different sectors that are vital to its success, to see where we were. The full (short) report is well worth reading.
Overall, the discussions were very positive although it was clear that social prescribing and its role is not yet that well understood, as National Voices CEO, Charlotte Augst, and Director of Personal Care at NHSE, James Sanderson, explain in this blog.
But there are challenges we need to face, especially as a charity sector, if social prescribing is to take off and help transform the way we think about and ‘do’ health.
We need funding, and we need funders to work together. As the report we contributed to reminds us: ‘Not all communities have the same access to community groups, activities and services’. So, without investment, social prescribing could ‘further entrench inequalities’. This funding will have to come from a range of bodies—by no means only from the NHS and Integrated Care Systems (ICSs)—but one way or another we need it to boost community capacity. Independent and charitable funders were clear at our roundtable that, while they have been funding this sort of work for years, there is a limit to which they are happy to work with a statutory sector that keeps changing its mind, and that funders are rarely in the business of long-term revenue funding.
We need collaboration
We need charities to collaborate with the statutory sector and with each other. In some places this works well, and relationships are good, but we know this is not easy in every area and tensions will exist—especially when those who have people referred to them are looking for funding (see more discussion in our blog How can the social sector support the further rollout of social prescribing?).
We need social prescribing link workers to be embedded in and drawing from the whole work of all the relevant partners in an area, and to not just be pinned closely to the side of the NHS.
The newly forming ICSs must be looking to support cross sector collaboration and think about the funding of social prescribing ecosystems. This might vary depending on the local context—so there may be roles for health and well-being boards or local voluntary, community, social enterprise (VCSE) alliances—but wherever possible this work should build on existing collaborations, not invent new ones for any bureaucratic simplicity reasons.
We need a national framework, not least to make sure that everyone is having a go at this. But we must leave exactly how things are delivered to local actors—including local councils and ICSs—as it will be, and indeed must be, different in different places. After all, this is a place-based approach to health, and needs and relationships between the VCSE and other bodies will vary by area.
We need local government in particular, but also other national services including those responsible for key areas like housing, benefits, and work, such as the Department for Work and Pensions and the Department for Levelling Up, Housing and Communities, to be part of the effort and not just interested bystanders. That will be vital.
We need data and lots of it. If we can share data across the NHS—at a national and local level—with the VCSE, it will help us much better identify needs and the capacity available in each area, and that could be transformational. This, as we all know, is easier said than done.
None of this is impossible—indeed in some places people are doing it already, for example the Bromley by Bow Centre has a social prescribing programme to respond to the high levels of health inequality and deprivation in their local community. And it is not okay to say that this has to go on the back burner while we deal with the immediate issue of massive NHS waiting lists. For this is all about reducing the number of people who end up having to go to GPs, A&E or to hospital.
Rishi Sunak and Liz Truss may not be agreeing on very much at the moment, but let’s hope that whoever wins the Conservative leadership election stands firm on social prescribing.