How to fix Social Prescribing?

On July 14th Macc is holding a voluntary sector assembly about social prescribing, where we will be helping the VCSE sector to write a manifesto about what we collectively want from social prescribing. This article is my personal take on some of the issues.

I was heavily involved in the planning stages of social prescribing in Manchester 4? Years ago, and have kept touch with it ever since, however, I’m not going to discuss here how the Manchester social prescribing service in works. This is a companion piece to an article I wrote just before the pandemic started which you may want to read first.

There are many models of social prescribing and I’ve put a few references at the bottom of this article in case people want to read about some of them. However, the underlying principle of all social prescribing schemes is the same as is the aim. The difference is in how this aim is reached.

The underlying principle is that people with long term health/social care needs need more than help to fix whatever the problem is (diabetes, dementia, drug issues, debt), they need help to live a decent life, with all the things that make a life worth living, whether that is a nice home, taking the dog out for a walk, having a good relationship with your family or making model cars. The lack of a good quality life causes serious chronic problems and leads to more and worse illness.

The aim of all social prescribing schemes is to link people with local, city-wide and national assets. Some of these assets are VCSE organisations though many are not.

So, the problem for social prescribing is how to do this so it works for everyone.

Let’s start with the massive, huge elephant in the room question. What happens when the local assets don’t exist or are spread inconsistently across Manchester? Some places have lots of pubs, café's, parks, community centres. Some places don’t. What happens then?

Obviously, social prescribing can’t fix all of these gaps, the responsibility lies with all of us and especially with those people who are responsible for deciding where funding goes in Manchester. Everyone knows that there are huge gaps yet the health care system spends very little on “prevention” services. Instead, it tries to fix the problems that could have been avoided.

In my opinion, the role of social prescribing is to provide the missing data that feeds into health and social care planning. Do not underestimate the importance of this. Anyone in the health service will tell you that nothing happens without data. The data that social prescribing can provide in the systematic way that VCSE organisation cannot, is both about individuals and about local assets. For individuals it can provide data at a neighbourhood level, about what people want to improve their wellbeing such as friends, jobs, nice housing, hobbies, somewhere to walk the dog, and exercise. Even more importantly they can provide data about what does and doesn’t exist in neighbourhoods and what the priorities are, by linking the individual data with the local asset data. This analysis can then be used to provide the justification for more funding for local assets. The aim must be to bring all the neighbourhoods in Manchester up to an adequate level, not to divert money from one neighbourhood to another and spread the small pie even further.

Some social prescribing schemes think the answer is to pay for referrals. I’m not going to deal with why this is a terrible idea in this article but happy to have that discussion with anyone who thinks that it’s a good idea. Suffice to say that this kind of per capita funding has been a disaster for the health service.

The next issue I’ll focus on, is the model for linking people with local assets. There is a simple model, that might appear to be the obvious solution, but I think this model is fundamentally wrong. The simple model is to provide a referral service and one to one support. A social worker contacts the service, a worker carries out an assessment and then provides some one-to-one support including referral to local assets. The problem with this model, if that is all there is, is that it does nothing to change the overall system, in fact it reinforces it. The whole health and social care system works on an assessment and referral model. Social prescribing needs to be different and more like the holistic and creative models present in many VCSE organisations. One consequence of this referral and 1:! Service is that there is already an extensive movement to “professionalise” social prescribers so they can fit more easily into the existing system (and get paid more).

The role of social prescribing should be to support the process of transformation in health and social care. They should be the people who really know and understand what is happening in neighbourhoods and make sure everyone else knows. They are, or could be the experts in locality that advise everyone else and spread information about local events throughout the support system. So, if someone working as a physiotherapist at the hospital, or a GP, or a social worker needs some information about local walking groups they should be able to phone up for advice. Anyone who works in a strength-based way needs this kind of expert advice and there is general agreement that health and social care professionals need to be moving towards strength-based working. If you work for a drug user support service in the city centre, wouldn’t it be great if you could ask someone about what is happening in Blackley where your client lives. No health and social care professional can possibly know what is happening everywhere and though online databases work to some extent they are not trusted and often are out of date. People ne3ed other trusted people they can talk to.

In order to play this role of expert advice to the health and social care system the social prescribing service has to be working with organisations within the area. They need to be embedded and part of local communities, not another outsider coming in, they need local information and understanding rather than another career path. There are many other people in neighbourhoods who play some role in providing information about what is going on locally, from libraries to local newsletter publishers and faith groups. Social prescribing has a critical role in supporting the information infrastructure and making sure that the information gets to where it needs to be.

The final point that I want to make is about the role of social prescribing in bringing the people who use their services together. Let’s take an example. Imagine that a social prescribing service identifies a number of people within an area that want to go walking but there is no walking group. There are then a number of options. In a one-to-one service that’s it, no walking group, nowhere to refer and so no service. One option could be to run a walking group. Perhaps that can be a short-term solution. Another solution is to help people to set up their own walking group. A further solution might be to use the connections with local groups to work with them to get a walking group going. The point here is not that there is a right solution but that a social prescribing service should be thinking creatively about to help the people they are working with and working collaboratively with local organisations and supporting development. Solutions will vary from one place to another.

For me, the heart of social prescribing, is about employing local people who reflect the range of communities within a neighbourhood, who can act as the bridge between health and social care staff (many of whom who will not be local) and the communities that they work with.

Further Reading

What is social prescribing, King’s Fund

Social prescribing Eco-System, Torbay Community development Trust

Rolling out social prescribing, National Voices

How best to develop social prescribing? London South Bank University