Thoughts on CD and social prescribing

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With news that NHS England is to create an ‘army’ of social prescribing link workers it is paramount that community development (CD) is at the heart of the concept.

The Kings’ Fund says that social prescribing:

“enables GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services”

The importance of CD in social prescribing is borne out by the experience of Martin Webber in his blog that touches on the experience of social prescribing initiatives in Ripon. It is heartening to see CD as an acknowledged factor in Ripon’s success.

But as Martin admits there were challenges, not least the slow take-up by GPs to refer to the social prescriptions locally.

I can also testify to similar experiences in the Communities First programme in Wales; for instance in the Ebbw valley in Blaenau Gwent – location of some of the UK’s starkest health inequalities. One can have all the connecting activities and all the innovative/creative social prescriptions available but without the GPs on board then it can count for little.

But CD must not be allowed to become a euphemism for ‘well-connected’ or ‘engaging’ locally. The sector needs to interrogate correct use of the term. In this respect it isn’t just the pace, but the volume of referrals which is important. A critical mass of referrals creates abundant social capital within the groups involved in the activities. This in turn raises the capacity of the facilitators/hosts of the social prescriptions to continually-improve and refine their ‘offer’, and creates a pathway towards potential co-production of the prescriptions by the patients themselves. If social change isn’t achieved then it isn’t community development. The classic Reform vs Revolution divide. CD should not satisfy itself with helping the state meet its targets or find efficiencies; it must concern itself with more fundamental change and distributions of power.

A CD approach should always look to opportunities to collectivise and organise. We can all do more individually to eat better and exercise more. But there is a persistent, embedded societal trend of individualising poor health and blaming people’s own pathologies for their health challenges. The systemic problems within our economies, planning regimes and work cultures are also significant factors: the abundance of fast food chains in many towns; the increasing unaffordability of leisure and exercise opportunities; long work hours; and lengthy, sedantary commutes.

These are not just bad for our wasitlines but our mental health. Communities need to increasingly organise themselves in ways that create solutions to these: edible communities; buy local/indie alternatives; challenge lowest common denominator planning decisions; coworking spaces closer to people’s homes and communities; co-operative solutions to accessing leisure and healthier food (which drive down unit costs and make produce more affordbale for people on lower incomes); utilising under-used local assets such as school gymnasiums. All of these can have a positive, enabling effect on our individual decision-making that affect our health.

Community development workers – or connectors or link workers or whatever; the job title is largely irrelevant – can help initiate and pollenate these ventures that address these structural issues; and, in turn, share the learning to help other ventures. Our recent podcast about the Benthyg Library of Things in Rumney, Cardiff with Becky Harford is testament to how CD at the heart of an initiative seeks to pollenate – almost intuitively, organically – elsewhere and form alliances. It has had limited state support or funding to date (though that is about to change) and has self-organised. The opportunities afforded to the health sector are huge if patients themselves can shape, and be supported to shape, their non-clinical services.

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