At its best Social Prescribing is about trying to take a holistic strength based approach to health and wellbeing. It recognises that some of the solutions to improving health and wellbeing cannot be found in clinical interventions but instead already exist in communities, and by connecting people to these it is possible for people to build on their own strengths thereby improving their confidence and wellbeing.
NHS England has an ambitious programme of rolling out Social Prescribing Community Link Workers to all Primary Care Networks in England. Complementing this the Department for Health and Social Care has just established a National Academy for Social Prescribing (NAfSP) to foster the development of Social Prescribing in England.
The Strategic Challenge for Social Prescribing
Shifting a predominantly clinical NHS model to coproduce solutions with local communities is a significant cultural change. Some of the challenges include:
- If social prescribing is to have a real impact on General Practice there will need to be a radical change to the primary care delivery model. Not all GPs are convinced of the model and it barely reaches the acute sector.
- Local Government is not systematically involved in this NHSE programme (there are local examples where this has happened) developing holistic models will require multi-disciplinary engagement in neighbourhoods.
- The relationship between social prescribing and specialist services like community development, youth work, welfare rights, advocacy, health trainers and local area coordination, needs thrashing out – otherwise people will just be referred from one service to the next – or even worse specialist services (often supporting the most needy) will continue to struggle with lack of funding because some will believe that social prescribing renders all other services unnecessary.
- The voluntary and community sector has borne the brunt of the cuts under the Coalition and Conservative governments – it is already struggling to respond to demand – social prescribing risks overwhelming already hard pressed local communities.
- Inequalities – to date NHS England has seen social prescribing as something that can be rolled out equally across all practices – little thought has been given to whether this is a model that should place a greater emphasis on addressing structural inequalities – both with regard to resource allocation and service design.
These challenges mean that the NAfSP will need to:
- Gather and Share good practice
- Influence NHS services and General Practice
- Work as a critical friend with NHS England in the further development of personalisation
- If necessary challenge Government with particular regard to the impact of its policies and funding on communities and local government
- Ensure that it has strong links and some accountability to communities
Given the above challenges and actions needed to address these it is concerning that the NAfSP appears to be very reliant on the patronage of Matt Hancock the Secretary of State for Health and Social Care, who according to this FOI request has authorised:
- the establishment of NAfSP as a private company limited by guarantee – there has been no tender or approach to any existing organisation
- a direct initial donation of £5m of DHSC funds with the promise of more to come.
- the appointment of a board of directors for the company – with no external recruitment of whom at least 2 are active in the Conservative Party.
It is interesting that NHS England (who have a who have a Director on the Board and appear to have provided over £.6m) accept no responsibility for the funding of or appointments to this new organisation – despite Social Prescribing being a clear part of the NHS England action plan on personalisation.
Matt Hancock has close links with the Institute of Economic Affairs a free market think tank who have a clear position on charities that are funded solely by Governments, they call them “Sock Puppets”. In other words not really independent – just mouthing the interests of Government.
Given the NAfSP fits all the IEA ‘sock puppet’ criteria – a company with all directors appointed directly by the minister with 100% funding from government it is hard to see how it is well placed to drive forward an effective change agenda that will need to achieve two things. First, make sure that attention is paid to the needs of hard pressed communities and second bring effective independent challenge to the health system, key stakeholders and of course government to help local health systems become more more person and community centred.
Between now and the new financial year the new charity will be established – it will be important to be sighted on who is on the board, will key players be involved like:
- the local voluntary sector for example Locality?
- local government – the New Local Government Network?
- Universities with a track record such as the University of Westminster or Sheffield Hallam?
What do you think?