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Just what the doctor ordered?

Social prescribing is the new big thing in health. So what is it, why is so much money being ploughed into it, does it represent good value for money and what difference does it make? This week Nick Garbutt, editor of ScopeNI shares his thoughts on the topic.

Poverty, poor housing, inadequate education, environmental pollution and limited access to affordable healthy foods are all examples of factors that can impact negatively on health.

Many of these are related to policies of other government departments. The provision of clean drinking water, effective sewage systems and reducing environmental pollution have been just as important in improving health as breakthroughs in medical treatments.  The point is that improving health is not just the business of the health service.

It’s not just the business of government either. How we lead our lives is every bit as important to promote good physical and mental health. Physical activity, for example is good for both and we also know of factors that can be very bad for your health: loneliness and isolation, for example.

It therefore follows that the remedy for many ailments is not a bandage or a pill, but lies outside the health system.

And this is where social prescribing comes in.

The term itself, like so much jargon, is both ugly and misleading not least because it means different things to different people. There is no agreed definition. It is yet another example of people using and repeating terms without troubling to find out what they mean.

It is probably best illustrated by an example.

Mrs X is 79 years of age. Last year her husband of 50 years died after a long illness during which she cared for him. She is anxious, lonely and feeling very low so she visits her doctor. The doctor recognises that her problems are related to her bereavement and isolation. There are no pills or bandages for that. So instead the doctor is able to put her in touch with a professional who meets her, discovers her love for walking and is able to put her in touch with a local rambling club which she then joins. She goes on weekly rambles and meets new friends who she then socialises with. She still mourns the loss of her loved one, but her life has got meaning and purpose again.

That, in essence, is social prescribing.

And it is important. This example was around loneliness. And Loneliness and isolation are major drivers for poor mental and physical ill health.

Recent research shows that the overall negative effects are comparable to well-established risks such as smoking and alcohol usage. Clearly, as the population ages, so too will loneliness and it is therefore an important public health issue which doctors are in no position to tackle.

So Mrs X was helped by sitting down with a “link worker” who talked to her about why she felt sad, what she enjoyed doing and was able to come up with a “social prescription” to help her. The worker might have met her in the GP’s surgery or else in Mrs X’s home and, if she felt nervous about attending the group on her own would have offered to go along with her for her first walk.

Another simpler way of describing social prescribing is that it recognises that peoples’ health is affected by social, environmental, economic and other factors and seeks to address their needs in the round (or holistically for those who like jargon). And in doing so it supports people to take greater control of their own health.

Most of the activities that are prescribed are run by community and voluntary groups and so therefore their importance in delivering good health is central to this process.

Recently the Big Lottery Fund announced a £3 million grant to a social prescribing project run by the Bogside and Brandywell Health Forum in Derry/Londonderry. It follows a pilot which worked with older people in Derry and Strabane. The money will be used to expand the service to provide three social prescribers across Northern Ireland and a similar project in Scotland. Loneliness and isolation will be a key focus.

It looks like a good investment but what is the evidence?

Sadly, to date, there isn’t very much of it. A report from the King’s Fund which was published last year, concedes that “robust and systematic evidence on the effectiveness of social prescribing is very limited. Many studies are small scale, do not have a control group, focus on progress rather than outcomes, or relate to individual interventions rather than the social prescribing model.”

This is not surprising as it is difficult to compare the respective impacts of complex interventions or compare often very different schemes.

However what evidence there is suggests that they do have positive impacts on both mental and physical health and that they reduce pressures on NHS services.

It is important to stress that the absence of evidence about effectiveness does not mean that social prescribing is not effective, just that there is insufficient evidence to date.

Further research is needed but common sense tells us that helping address the non-medical factors that affect peoples’ health is a good thing and needs to be rolled out and that it will, over time, reduce pressures on the health service.

But wouldn’t it be nice if those behind it could agree on a simple, sensible jargon-free definition that everybody else can understand?

What do you think of the idea of social prescribing?  Do you think it could have a positive impact in your community?  Have you heard of schemes in your local area?  Share your views in the comments section below.


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Previous comments ...

Yvonne Hutton 23-Jul-2018 at 09:40 hrs

I am glad that the problem is being recognised that pills are not the answer to everything. Maybe managing finance and looking after oneself could be more of a subject at school. There are doctors who are willing to write scripts for whatever the patient suggests but people need educated that they can help themselves a lot more than they do. There are those that will milk the system and be willing to take, take take with no effort made themselves. Some folk would rather remain lonely and miserable than joining groups to help them . The saying you can take a horse to the water but you can't make it drink sadly is true of human beings too. Trying to get folk with similar problems or interest together only works when the client will agree.


joan leckey 22-Jul-2018 at 17:00 hrs

A great idea Being in a wheelchair can be very lonely but my community support worker helped me to get out more


Anne Alexander 22-Jul-2018 at 06:04 hrs

It is basically a good idea, provided it is not used as a substitute for treating physical illnesses. The name is not great. Perhaps more advertising of social groups etc could be done in waiting rooms and in online practice information. Also if someone is bereaved keeping in contact with them is important.


Helen Shaw 21-Jul-2018 at 14:23 hrs

Good idea. Loneliness affects all age groups and social groups too. Recently a man on the Nolan show said he made an effort to go out every day to the shops in order to meet people otherwise he wouldn't have anyone to talk to. I sometimes see young girls with babies wondering around shopping centres. They look lost and I imagine they go there for company?


Linda Campbell 20-Jul-2018 at 22:49 hrs

Excellent concept - but it is already happening and has been in many areas for years albeit under another name/service. The term Prescribing suggests this is something only Doctors (or non-medical prescribers) can do, whereas this should be something all health/social care professionals/certain disciplines have within their grasp in order to provide effective and efficient, holistic care.


charlie lynn 20-Jul-2018 at 21:20 hrs

Just want to say that this sounds a very positive thing to me, all being well it will get the funding it deserves.
Charlie Lynn.


E.Murphy 20-Jul-2018 at 21:00 hrs

I think it is a brilliant idea that doctors are finally recognising that there is also a great need for social intervention. Everyone knows that we need to be socially connected to survive. So I don’t understand why we need to look at research to find evidence for something which is inevitable. I think a link-worker is a great idea as they can be that crucial support needed for the person who has lost the confidence to find the right social connections by themselves. I’m not sure whether or not there are any such schemes in our local community but if there isn’t, there certainly should be. This can only be a positive step forward.


Anne Johnston 20-Jul-2018 at 17:05 hrs

I'm not sure that funding is the answer except where walk leader training is concerned. Our walking group has been going now for 19 years. It's been of benefit to members who have been bereaved, helped to improve health and well-being etc but we don't seek funding. How would this be of benefit to us?


Doreen Patton 20-Jul-2018 at 16:59 hrs

Jargon and more jargon! Day centres etc were closed and now we are expecting the Big Lottery Fund to cough up the money for the community groups to replace these activities. We are expected to have more people cared for in their own homes -- to be got up out of bed at 7am, see the carer for 10/15 minutes, sit in the corner until a carer arrives to make lunch, sit through a long afternoon until the next carer arrives for 10/15 minutes and then the next carer puts you to bed at 7.30pm. Someone some where along the line did social prescribing of loneliness, isolation and depression for many of our elderly population. Maybe going back to old times with less jargon would be a good idea. While I have nothing against the lottery but does the use of these monies for social prescribing encourage more gambling, just a thought.


Joy Scott 20-Jul-2018 at 15:42 hrs

Social prescribing is long overdue


Grainne Taggart 20-Jul-2018 at 15:41 hrs

I work for a service within South Eathern Health Trust called Caring Communities Safe & Well. the aims of our service is to tackle social isolation & loneliness of people over 65 years in our Trust area by offering information, advice and support. We run a Volunteer Befriending scheme where we ask our volunteers to give up 1 hour a week to visit an older person in their own home for chat & companionship.
for further information please phone : 028 97566934