“Social Prescribing” will not Cure Our Social Ills

By Lucinda Maitra

Social prescribing is a concept that has been gaining traction in the UK, though it has been used since at least the 1990s. It refers to a process by which health professionals refer patients to undertake a form of social activity which is aimed to improve their health and wellbeing. The current initiative by the NHS which began with 23 projects in 2018 has reached over 100 this year. The system works by using community support workers usually called ‘link workers’ whose role is to suggest local social groups including arts and cultural activities which are suited to the needs of each patient.

Tory Health and Social Care Secretary Matt Hancock has recently announced further ambitions to roll out social prescription across the UK. In October plans to set up the National Academy for Social Prescribing receiving £5million funding were released.

Social prescribing schemes have been promoted as a cost-effective measure to tackling the prevalence of long-term health conditions. As a concept, social prescribing seems like it has the potential to be a good strategy through utilising the support of local services. But a fundamental pitfall of this initiative is the focus on managing the effects of poor health, rather than properly addressing the range of social determinants that could be could be causing various conditions. At its announcement, Hancock said that the new academy is “about all of us in health, arts, culture, sport, communities coming together around one simple principle: that prevention is better than cure.” But in reality, social prescribing is neither prevention or cure. It aims to direct patients to already existing community services- which patients might not be aware about. However, it does not impact important factors which influence people’s health such as economic stability, access to resources such as safe and affordable housing, education, healthy foods and good quality living environment.  All of these factors have been exacerbated by the neoliberal economic system of the past few decades, and by the austerity programme introduced in 2010 .

Though activities ranging from singing to gardening have clear benefits, these schemes are not realistic in tackling the scale of issues people are currently facing. Certain doubts about the implementation of the scheme have been cast about the from health professionals. For instance, The British Medical Journal stated that there has been very limited evidence for the overall effectiveness of social prescribing.

Whether the initiative is considered effective or not by the standards of health professionals, the capacity of community services to handle such demands is another question left unanswered. At the same time as the fallout of years of austerity and huge cuts to arts funding, there is an increasing pressure on small scale organisations to serve multiple and often very complex social purposes. The scheme expects community groups and volunteer organisations to accommodate people who have been referred to their services without providing additional funding. The concept of social prescribing also relies on the assumption that there are plenty of relevant services out there suited to the needs of local people.  Failing to consider such issues and complexities, the so-called “free social cure” is promoted as an innovative way for the NHS to approach the proliferation of chronic and long-term illness.

According to David Phizackerley a major risk of social prescribing is that it “will be expected to provide a low cost solution to many complex societal problems Yet again, the priorities of the Tory government lie in cutting costs over and above people’s health and welfare.

Rather than put volunteer sector organisations under even greater strain, we need to tackle the root causes behind the growing need for social forms of support. Crucially the economic inequality leading to unequal distribution of resources which determine people’s health. Engagement in arts and culture is an important way of improving wellbeing, but it should not be instrumentalised in a way which values only its potential social purpose.