Social Prescribing: England

Tracey Crouch Excerpts

Tuesday 1st February 2022 Westminster Hall

[Alexander Stafford (Rother Valley) (Con)]

I beg to move,

That this House has considered social prescribing in England.

I wish first of all to make clear to the House my interest as chair of the all-party parliamentary group on health and the natural environment. I am delighted to be sponsoring what is, to my knowledge, the first dedicated debate in the UK Parliament on social prescribing. There is no doubt in my mind that this debate is timely, if not overdue, given that social prescribing as an effective and respected field of medicine has come to the fore in the past few years and accordingly has an important role in the future of our health system.

So what is social prescribing? Put quite simply, social prescribing embraces the need for psychosocial support to be considered alongside biomedical interventions, to take us back to a more natural way of keeping well and improving our health when things go wrong. Importantly, social prescribing is about being connected to activities in our communities to improve health and wellbeing, whether by joining a community choir or running group or volunteering at a local nature reserve.

To understand why social prescribing is crucial to the future of care, we must understand its place in the health and social care context. All Members can agree that biomedicine is brilliant, and there is no better example than the Government vaccination programme for covid-19. Biomedicine will always play a crucial role in supporting people’s health and wellbeing. However, we have also known for a long time that what determines our health is not what goes on inside hospitals and GP practices. We also know that biomedicine has limitations—for example, addiction to opiates.

Recent guidance from the National Institute for Health and Care Excellence promotes the use of exercise for pain, alongside drugs. In fact, the NHS chief pharmacist’s recent report into over-medicalisation demonstrated that one in five over-65s are in hospital not for a condition they have, but due to the medicine they take, while 10% of prescriptions dispensed address the symptom and not the cause of a person’s depression. Evidence also shows that one in five GP appointments are for non-medical needs, such as mental health, relationships, housing, loneliness, social isolation, managing a long-term health condition and debt.

[Tracey Crouch (Chatham and Aylesford) (Con)]

I congratulate my hon. Friend on securing this debate. I am not sure if he was aware, but I was the world’s first Minister for loneliness. We produced a strategy to tackle loneliness, of which social prescribing formed a significant part. As a consequence, social prescribing was beginning to be rolled out, to the benefit of our GPs up and down the country, supported by a dedicated team of link workers, who really grasped the importance of tackling loneliness through social prescribing. Will he join me in thanking all those link workers, who get why social prescribing is important and continue to signpost people towards organisations that tackle loneliness?

[Alexander Stafford]

I thank my hon. Friend for that intervention and for all the work she did as Minister for loneliness to address this important issue, which she continues to drive forward, including in all-party groups. She is exactly right: link workers are vital. Indeed, a big part of my speech is about them, because it is so important to give them the support they need and thank them for their great work to improve the health of our nation.

Demand for GP appointments has increased by 30% compared with pre-pandemic levels, but the ecosystem of social prescribing support is fragmented. Healthcare professionals have limited visibility of what local support is available, as directories of services are often outdated and the referral pathway to different agencies is complex. There is also significant inequality of access to nature. About one third of the population accounts for 80% of all visits taken, and 2.69 million people do not live within a 10-minute walk of a green space. People from low-income households are about 25% less likely to live within a five-minute walk of a green space. Someone from a black, Asian or minority ethnic background is nearly four times as likely as a white person to have no access to outdoor space at home. Almost 40% of people from ethnic minority backgrounds live in areas most deprived of green space.

The inequality of access to green space seen for adults in England is also seen among children and young people. Most of our children spend not nearly enough time outdoors. Unequal provision means that those at greater risk of poor physical and mental health often have the least opportunity to benefit from green space. In other words, inequality breeds greater inequality. Improving contact and connection to nature is one way to help break that cycle of inequality.

It is exciting to see the positive impact of social prescribing borne out by the evidence. When we talk about health, we should always talk about evidence. Data indicate that people who visit nature regularly feel that their lives are more worth while. There are links between a greener living environment and higher life satisfaction, including improved mental health and reduced stress, fatigue, anxiety and depression. Among people who have good access to nature, inequality and mental wellbeing between different social groups are vastly reduced.

People who visit nature at least once a week are almost twice as likely to report good general health. However, it is an individual’s feelings of connectedness with nature that are important for their wellbeing. When controlled for time spent outside, people with high nature connectedness were 1.7 times more likely to report that their lives were worth while, versus those with low nature connectedness. Evidence shows that living in green environments is associated with reduced mortality, and green space may mediate detrimental health effects of long-term deprivation.

Since the pandemic, 43% of adults say that visiting green spaces has been even more important for their wellbeing. The evidence is equally impressive for children, reinforcing the point that schools and other educational settings are crucial gateways, if we are to ensure that all children have contact and connection with nature, especially those who otherwise have little opportunity to access the outdoors.

We have already made great progress rolling out social prescribing across health and social care services. For the NHS, social prescribing is a relatively new model of care that improves the health and wellbeing of individuals. It builds community capacity and reduces demand for statutory services, particularly GPs—we all know the pressure GPs are under at the moment. Social prescribing sits at the heart of NHS ambitions for system change, as a practical embodiment of personalised, joined-up, preventive, community-based care that addresses the social determinants of health.

In 2019, the NHS long-term plan committed to the recruitment of 4,500 social prescribing link workers. Link workers take a holistic approach to health and wellbeing, connecting people to community groups and statutory services for practical and emotional support. The NHS long-term plan envisions that social prescribing link workers would work alongside other roles being created in primary care, as part of multidisciplinary teams. Those teams include other personalised care roles, such as community pharmacists, mental health workers and health and wellbeing coaches.

Social prescribing is part of a wider suite of community-based interventions, including programmes around hospital discharge and higher intensity use of accident and emergency services. Together those programmes are part of an overarching shift towards greater collaboration between health services, systems, capacity and assets of wider local communities. The plan envisions that that would be funded by bringing together resources across systems to support thriving health communities.

Making that shift is now more urgent than ever. The covid-19 pandemic laid bare the devastating realities of health inequalities across our communities. It has shown that we need to do better at reaching out to marginalised communities, closing the gaps in the support available in the most deprived areas. The pandemic has also increased the urgency of finding a way to support people to stay well within their communities, reducing pressure on health and care services. Social prescribing in its broadest sense encompasses a whole ecosystem of support for people’s health and wellbeing in the community. It is a core priority for much of the voluntary community and social entrepreneur sector.

My seat of Rother Valley is a former coalmining area with deep pockets of poverty and deprivation, and many of my constituents suffer from lung conditions caused by exposure to harmful particulates in the mines. I have witnessed at first hand the poor health outcomes associated with a lack of access to high-quality green space, the mental and physical costs of social isolation from one’s community, and the price of late stage reactionary overmedication, in contrast to early preventive measures. In my experience, it is true that those at greater risk of poor physical and mental health are the most likely to benefit from green space, but the least likely to able to access it. Members of my family who work in the NHS have made me acutely aware of the pressures on the national health service from preventable conditions. I am thus determined to increase access to nature for left behind communities, and therefore to improve my constituents’ lives.

I recently announced my campaign for the creation of a Rother Valley leisure arc, stretching from Treeton dyke through Rother Valley country park via Gulliver’s Valley theme park resort, taking in the award-winning Waleswood caravan park and family favourite Aston Springs farm, to the Chesterfield canal, where I wish to see the construction of the Kiveton Park marina and the reopening of the nine-mile stretch of canal, including a Rother Valley link to the rest of the waterways system. The Rother Valley leisure arc aims to make Rother Valley the heart of tourism in South Yorkshire, bringing jobs, wealth and farming to our area. It will be a vibrant and dynamic leisure cluster, with provision for exercise and hobbies, physical and mental health, education and skills, business and employment, and tourism.

The Chesterfield canal is a crucial part of the Rother Valley leisure arc. Accordingly, I am pleased that the Canal & River Trust is focusing on the concept of blue health, which recognises the health and wellbeing associated with spending time by the water. The South Yorkshire and Bassetlaw integrated care system social prescribing pilot, funded by the Department for Environment, Food and Rural Affairs, seeks to better understand the best ways to connect residents with their local green spaces. Rotherham Titans rugby club also hosts a great social prescribing programme, which is already achieving great things.

Members and my constituents will know that I am a history buff, so it will be no surprise that I welcome the growing body of evidence about the wellbeing benefits of engaging with heritage and the historic environment. Local to Rother Valley, Heeley City farm’s community heritage team have engaged thousands of people from the Sheffield area, including many volunteers, work placements and general participants of all ages, in a variety of local heritage and wellbeing projects. In 2020, it played an important part as a community hub in Sheffield’s voluntary sector response during lockdown.

As a result of my strong belief in social prescribing, in April 2021 I founded the all-party parliamentary group on health and the natural environment to investigate the benefits that connecting with the natural environment might have on health and wellbeing. Recent sessions have focused on evidence and transforming delivery. We would welcome the Minister coming to speak at one of our sessions in the near future, if she is available. Our secretariat, provided by the National Academy for Social Prescribing, is working on fostering closer working relationships with other all-party groups that are focused on the theme of wellbeing, such as that of my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch).

The National Academy for Social Prescribing, known as NASP, was established in 2019 by my right hon. Friend the Member for West Suffolk (Matt Hancock), who was then Secretary of State for Health and Social Care, to work with the NHS to accelerate the development and expansion of social prescribing activities delivered by voluntary organisations and community groups across the country. Over the past two years, NASP has worked with a wide array of partners to develop a number of ambitious and varied programmes.

One such programme is Thriving Communities, a national support programme for voluntary, community, faith and social entrepreneur groups. It works alongside social prescribing link workers to support communities impacted by covid-19 in England. Another programme is Accelerating Innovation, a partnership between NASP, the Royal Voluntary Service, NHS England and NHS Improvement that supports national voluntary organisations to develop their social prescribing ideas so that they can develop projects and approaches that have a greater impact and a wider reach, and that help to reduce health inequalities.

Furthermore, NASP has formed a Global Social Prescribing Alliance in coalition and collaboration with the World Health Organisation, the UN and the World Health Innovation Summit, with the aim of establishing a global working group dedicated to the advancement of social prescribing information, collaboration and innovation. The membership is currently 18 countries and growing. NASP is working through academic partnerships and NHS England to bring together leading researchers in the field of social prescribing to ensure that the evidence on it is accessible, useful and compelling. All of those programmes work closely with NHS England with a focus on outcomes for people, local systems and communities.

There are several areas of focus for my APPG and NASP in the coming months, in respect of forthcoming reports and policy developments. These include the implementation of the Government’s 25-year environment plan, the recently published Dasgupta review, the Environment Act 2021, the landscapes review by Julian Glover, and the Chief Secretary to the Treasury’s cross-Whitehall committee to set the direction for the comprehensive spending review on using access to outdoor spaces to support better health outcomes. I hope that the Minister will touch on those developments, and tell us more about their impact on the expansion of social prescribing in our health system.

As is relevant for all models of care, the Minister will be pleased to hear that social prescribing provides good value for money through reductions in GP appointments and financial savings in drug prescriptions and freed-up GP salaried time. For example, poor mental health is estimated to incur an economic and social cost of £105 billion a year in England, with treatment costs expected to double in the next 20 years. As for poor physical health, the cost of obesity alone to wider society is estimated at £27 billion. However, urban green spaces support 2.1 million people to adhere to their weekly physical activity guidelines, which is worth £5.6 billion and avoids health service costs of around £1.4 billion. These are good savings; they are better for people’s health and for the Government’s wallet.

A recent assessment of the economic impact of social prescribing by NASP, which drew on the best available evidence, concludes that social prescribing can be a cost-effective intervention that reduces pressure on primary care, especially GP services. NASP’s preliminary forecasts indicate that the NHS social prescribing link worker programme could save the taxpayer more than £480 million over three years by reducing the need for GP appointments, which would cover the total cost of the programme.

There is no doubt that investment in green space is good value for money. For example, a study into the economic values of Birmingham’s city-wide Be Active programme found that approximately £23 was recouped for every £1 spent, which is a huge return on investment. The valuation of urban parks in Sheffield, my constituency of Rother Valley’s local city, showed that for every £1 spent on maintaining parks, there was a benefit of £34 in health costs saved.

The Minister will appreciate that I have some policy asks of the Government to accelerate the development of social prescribing, in order to provide direct support for our recovery from the pandemic and the Government’s levelling-up agenda. To achieve these aims, I ask the Department of Health and Social Care to focus on eight main policy asks—so not too many.

First, we must accelerate the recruitment of social prescribing link workers, so that all 4,500 are in post by 2023. Secondly, we must ensure that the newly created integrated care boards have a duty to produce specific plans in their area for implementing social prescribing. Thirdly, we must build leadership, skills and capacity in the voluntary sector, by investing in NASP’s Accelerating Innovation and Thriving Communities programmes. Fourthly, we must commit to social prescribing being at the heart of the Government’s levelling-up and health inequality agendas.

Fifthly, there must be faster and greater levels of funding into social prescribing activities and services, particularly grassroots organisations such as charities, aligned to the health needs of the population within each of the 42 new integrated care systems. Sixthly, there must be greater investment in the digital infrastructure to facilitate social prescribing. Seventhly, every social care organisation and every hospital should have a dedicated team of social prescribing link workers. Eighthly and lastly, social prescribing needs to be integrated into the everyday processes of frontline health and care staff, to change the culture whereby it is easier and more natural to prescribe a pill than to make a social prescription.

It is clear that social prescribing can improve the physical and mental health and wellbeing of our population, improve people’s lives and save money. It not only helps to manage existing conditions, but addresses underlying issues that cause poor health and wellbeing, and so helps to prevent future illnesses. It is better to prevent future bad health than to cure it.

Social prescribing supports local projects in the community and fights social ills, such as loneliness and isolation, which traditional medicines do not address. By integrating social prescription into our health and care system, we will simultaneously save taxpayer money and take the strain off the NHS, freeing up capacity for essential treatment. Social prescribing has an enormous role to play in the future of health and care in England, so I am proud to be the first parliamentarian to make the case for it to the Minister.