Happy Social Prescribing Day. This is a time to celebrate all the amazing work you are
doing. My ask is for everyone to take time to reflect on this, and give yourself some self-
love.
There is a real movement, and recognition that interventions that help to address more
social issues, have a significant impact on wellbeing.
In this blog I’m providing examples of best practice, some of the challenges and whether
social prescribing requires a paradigm shift.
Best practice in Secondary Care
A great example of this is St Bartholomew’s hospital heart pathway programme, which has
incorporated social prescribing. When people are discharged from hospital they are asked ‘
do you struggle to make ends meet’?. The response to that question can open many doors
for that individual, which may not have necessarily been there before. The team have
recognised that for too long, discharging people into a lifestyle that doesn’t promote health
and wellbeing, will likely lead to that person being readmitted into the pathway. In one recent
study, it was found that heart attack patients from a socially deprived background are at a
53% greater risk of premature death, and 58% greater risk of readmission into hospital.
“I would consider [social prescribing] to be one of the priority innovations that any hospital
leader or executive should be considering, especially with the evidence we know about the
significance of social deprivation to clinical outcomes and success of treatments” Dr Andrew
Wragg, Medical Director at St Bartholomew's Hospital says.
Challenges -
The above provides a great example of how social interventions can improve people’s
outcomes. However, as Chris Dayson, Professor of Voluntary Action, Health & Wellbeing
says:
“At risk of sounding like a stuck record, this #socialprescribingday I think it is important to
highlight the challenges facing small local voluntary organisations and community groups.
Instinctively, they want to support social prescribing, but face real challenges meeting the
additional demands it places on their capacity without additional resources to support this.
We wouldn't ask a pharmaceutical company to provide drugs for free, so we shouldn't expect voluntary and community providers to do this either.
If social prescribing can't find an equitable way of supporting voluntary and community
providers there is a real risk that the approach will become an over-medicalised extension to
existing systems and clinical pathways, rather than a more radical community-based model
of prevention.
This might be an uncomfortable message given the challenges facing the NHS and
Integrated Care Boards, but I firmly believe that there are collaborative place based solutions
that could be developed that could enable the risks and rewards to be shared across sectors
and organisations. These are needed more than ever”.
Paradigm shift
Some of you will know that I’m a huge advocate for Asset Based Community Development
(ABCD), Compassionate Communities, whatever you want to call it. Having had the
opportunity to participate in a workshop held by Cormac Russell, early on in my role, it really
resonated with me, and set the direction of travel. I was also fortunate enough to listen to
Cormac at The Social Prescribing Conference, where he critiqued aspects of the approach,
but in a way that got everything thinking differently.
In a recent paper, We Don’t Have a Health Problem We Have a Village Problem, Cormac
Russell highlights brilliantly the need for a paradigm shift in Social Prescribing.
“Thomas Kuhn, who popularised the term paradigm shift, noted that at the edge of every
dominant paradigm are new ideas that sometimes coalesce to form a new paradigm. To end
on a positive note, perhaps it is possible for social prescribing initiatives to pivot from
prescribing social solutions to merge with other efforts to facilitate collective citizen-led
health creation. Perhaps they can begin to genuinely support the birthing of approaches like
those we are seeing in Greater Rochester. This form of ally building, alongside strategic
investment to support a resurgence in co-operatives, would trigger a step change. The
seeds of change already exist, but more work is necessary to lay the foundation for
substantive action.
The first step is recognition of the root cause. We must come to the realisation that we do
not have a safety problem, nor a social care problem, nor a youth problem, nor even a health
problem; what we have is a village problem. The solution does not lie in reforming each
institutional silo but in organising our silos the way people organise their lives, so that the
neighbourhood becomes our primary unit of change. Such a step change demands genuine
place-based action, pooled budgets, and the release of resources to work upstream to stem
the subsidence of our social foundations. In the final analysis, the actualisation of true
population health will only be conceivable when alienated citizens rejoin their communities
and make contributions; then health will be enjoyed by all. This journey begins at the local
level, with caring communities driving the discourse and health care systems taking on a
supplementary role”.
I strongly believe for too long, including myself, we have outsourced our health to services
that don’t necessarily serve us. This is not to say that there is not the need for medical
interventions, my point being that an overreliance on a medicalised model does not address
the root causes. At a recent event I attended, Dr Rangan Chatterjee openly admitted that
despite 20 years of medical experience, the patient/individual will know there body far better
than I.
I think some in the medical world can view more person centred social approaches as a
threat to conventional medicine. To me, I see this approach as something to complement the
medical model. My ask is for all of those working in a more traditional way is; how could a
more person centred holistic approach, help the people you are working with?? As opposed
to reaching for the medical cabinet, could a social intervention help alleviate the root cause
of the issue, and not cover over the cracks.
As always any questions please do get in touch david@3sg.org.uk
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