Social Prescribing as an NHS Sustainability Strategy

Awareness of Social Prescribing is growing fast in the UK. As it emerges in our collective consciousness and evolves in practice, the reach and meaning of the term is still malleable. It’s a powerfully simple idea: That a GP or health professional can suggest anything from healthy eating resources, to volunteering, gardening, befriending services or even Parkrun as a way to help patients improve or better manage their mental and physical wellbeing.

Its common-sense logic and principles are attracting practitioners and the public to this less formal, less clinical way of harnessing the assets that surround us in our everyday lives to improve our health through our communities.

It has been an exciting privilege to support a Social Prescribing project over the past six months based in South London. Funded by the NHS and Guy’s & St Thomas’ Charity, a coalition of GPs, community leaders, non-profits and national and community charities have focussed their efforts on North Lambeth CCG. Medical practitioners, community leaders and interested citizens have agitated, activated, explored and connected people and activities that can improve the well being of the area.

As the project finishes its scoping phase and the teams prepare their ideas to pitch for funding, I want to share some insights from the process.

Individuals and Systems: Health vs Healthcare

At NESTA’s annual health conference The Future of People Powered Health, NHS Chief Executive Simon Stevens mentioned that “The NHS stands for ‘National Health Service,’ not ‘National Healthcare Service.’” It is a crucial distinction, as we too often imagine that the NHS is simply there to react, to fix, to mend, to care, or to treat once a problem is already there. Since its founding in 1948, there have been massive shifts in the health and health problems of the UK, unforeseeable at the time. A huge rise in chronic illnesses, requiring months of intensive rehabilitation or lifetimes of management, cause much suffering in the UK population and require much of the resources of the NHS.

Many long term mental and physical and chronic conditions can emerge from or be exacerbated by unhealthy lifestyles. Such a battle can’t be solely fought in hospitals and clinics – We must focus on prevention through healthier lives; and to do so we must reach out to our streets and parks, our back gardens and community centres, our schools and bicycle lanes.

Social Prescribing can connect people to resources, local community groups, services and information that help us live healthier, in ways that are meaningful to us . They can improve our everyday health and mental wellbeing, but also alleviate pressures on our NHS.

Insights from North Lambeth CCG

Aviv Katz and I co-facilitated a series of workshops and helped establish and manage an online-and-offline coalition of professionals, patient representatives and organisations in and around North Lambeth, to develop ideas, gather and share knowledge and sustain connections that would elevate the role of social prescribing in the area and increase its impact. Just six months in, I have some examples of what we are learning to share with you:

The Process is the means and the end

In Lambeth, a co-creative process with a focus on training and skilling everyone up is having the desired effect of catalysing a community of practice. Getting team members to conduct enthnographic research, for example, has already shifted how some view their own role, how they frame up discussions around how people live their lives, and how they talk to them about how they want to improve. Some have kept up such practices beyond the relevant phase in the project because of the many benefits that come from working in new ways with users.

This is a common theme of service design work. To effect change – from simply participating to truly owning a concept or way of being and transforming the fundamentals of how an organisation behaves, the designer-as-facilitator needs to bring people with them, share the practice and encourage its growth.

Continuing a Coalition, Giving Momentum to a Movement

There is a great deal to be said for leaders and participants maintaining the momentum and connections and knowledge being amassed in the group. Besides designing and delivering more representative and focused services, a conference was mentioned as one way of stimulating knowledge sharing as well as continuing this current process and its creative gatherings.

Informality and Familiarity is Key to Meaningful Participation

Services that touch the most important parts of our lives – our mental and physical health, bereavement, childcare and housing are often organised and professionalised in ways that cause citizens to feel disempowered, uninvolved, ‘served to’. The potential of people and those close to them, their networks and local knowledge have an important part to play in services that are more inclusive, meaningful to us and ultimately effective. Social Prescribing should not feel like you are being handed an instruction by a professional, but being invited to join in by a friend.

Public-System Symbiosis:

Healthy Cycles or Unhealthy Spirals

(above) Social Prescribing satisfies many of the pillars of new care models as defined by the NHS

The NHS must embrace social prescribing and other proactive, preventative strategies to improve the health and lives of the public, and also to ensure it relieves pressure on itself to keep growing and strengthening. It is entirely positioned to benefit from a healthier public.

In my years living and working in the US, I saw the opposite. ‘Healthcare’ (note the phrase ‘health’ is not used), is the the largest industry in the US after the military, and sometimes damningly referred to as ‘the sickness industry.’ Part of my work as a service designer and ethnographer in the US was to visit the homes and workplaces of regular people and professionals, and observe and interview them about how they lived their lives in order to develop better services and products to meet their needs and aspirations. Many of these projects were for health clients, or touched upon them. I was astounded by how many people had suffered great hardship, including not seeking medical help for serious injury or illness, bankruptcy (the #1 cause of which in the US is ‘medical debt’), family breakup or even staying with abusive partners because of health insurance, or lack of it.

The Affordable Care Act (also known as Obamacare) was a significant step towards removing perverse incentives in the system. It squeezed and re-focused providers and insurers away from profiting from illness or refusing treatment, and towards profiting from keeping their customers healthy and treating more proactively to reduce risks in the future. It was not the full solution to shift from the existing system to universal healthcare, but its undermining by the Trump administration is a major blow to American society.

The NHS is our system – it belongs to the public, but we also have a responsibility towards it beyond the economic and political. Proactive, preventative health should be its sustainability strategy, of which Social Prescribing is a powerful tool. But as individuals, we should consider that healthier living, in big and little ways every day, can be our best way to support it.