Is social prescribing a great step forward in healthcare or a cynical move to use cheap or voluntary services to plug increasing gaps in a massively underfunded health service? Steven Carne raises some questions.
“Where are the safeguards?”
“Safeguards. Have you got a clinical support person? What happens if someone on your creative arts therapy course has a violent episode, breaks down in the room and stabs someone with a large paintbrush?”
This is a frequent conversation I have with creative practitioners about their ‘health and wellbeing’ work, especially as recent NHS England policy has spawned a magical lumping together of mental health and other clinical services into ‘Culture Arts Heritage and Wellbeing’ - and the wonders of social prescribing.
Having run arts projects in schools, youth clubs and worked in community development since the 80s I totally agree that the creative and social arts are good for everyone’s wellbeing and society in general.
But if creative arts courses, gardening and walking groups become volunteer community-based replacements for solid, experienced clinical care, is that a good thing?
Cuts to caring
Traditionally social prescribing was part of a trusted GP/patient relationship and referrals to creative or social groups were part of ongoing treatment usually with a team offering support. Good medical care is an artform in itself. The old NHS used to celebrate what I call “The Art of Caring”.
But continued severe cuts to GP funding and herding GPs into county wide Primary Care Networks (PCN) with fixed (and reduced) ‘population budgets’, means that the GP-patient relationship has changed. Having a real conversation with any GP has become near impossible.
These days, social prescribing is the means by which GPs, nurses and other primary care professionals connect patients to a range of local, non-clinical services. Patients are referred to link workers who take a holistic approach to their health and wellbeing, connecting them with community groups and statutory services for practical and emotional support.
Receptionists are instructed to filter your call and decide if you see a GP, a nurse or be redirected to the link worker. These are the GP gatekeepers who, with little or no knowledge of a patient, can direct people to gardening, a choir, walking or knitting and for the braver ones - a creative art!
As Simon Ashley Cross, NHS campaigner for 17 years said: “Social prescribing would be all fine and dandy if it were not a cynical move to use extremely cheap or voluntary services to plug massive and increasing gaps in massively underfunded health services. In its pure form it is a great complementary service, but this is being postulated as a replacement for parts of services currently provided by the NHS.”
Rather than admit to a deliberate ten-year lack of funding, and failure to successfully recruit future GPs and nurses, the Government’s answer is to employ an army of non-medically trained link workers to signpost patients away from GPs and into the hands of the local Community Volunteer Services and its partners.
The role for charities
There has always been a place for charities in the NHS, reliant on NHS Grants to help support local services. But one CEO of a Lincolnshire charity with a long history of this type of work is angry at the new focus on Community Volunteer Services (CVS) and the money that is being diverted to them.
She said: “Social prescribing has been carried out by charities for years, in our case since 1917! It’s not new. The CVS has no track record for being competent to deal with people’s social issues. The money should be given to grassroots charities who deliver on the ground to people who need support.”
In theory, link workers have GP input into their signposting decisions. But in last year’s National Association of Link Workers annual review, over 30% of them – having been in post for less than a year – were considering leaving the profession. 29% of social prescribing link workers plan to leave in the next year due to lack of clinical supervision and support according to NALW survey, giving “lack of clinical support” as their reason. We have to question if ‘care in the community’ in the ‘right place at the right time’ (NHS England Speak) is working.
A nurse/dance teacher had this to say about her experience in the very early days of the push by NHS England: “I signed up for the scheme, went to meetings, did all the paperwork. Tried to put a poster in my local surgery for the scheme. They didn't even know about it and wouldn't take the poster. It ran for two years, with a management team of about 6. The GP surgery remained oblivious and I sent in the requested info on referral numbers every month. I received not one referral.”
Add-on or replacement?
A good GP or senior nurse can spot symptoms of deeper underlying problems and early intervention can prevent more serious (and more expensive) conditions arising. Many early stage treatments are being denied at GP level because they are defined as ‘low clinical value’ and even NICE, The National Institute for Health and Care Excellence, is now looking at cutting chronic pain treatments. We have to ask if prescribing creative art and social activity is really a good replacement.
A scathing community nurse in Milton Keynes said: “It’s all been hyped up and packaged as some solution. In the days of Sure Start and all the proper services, there were nice add-ons like little groups often doing something arty, crafty. The problem is the services have been taken away and the nice little add-ons are being marketed as the treatment. We aren’t going to fix all the MSK (Musculoskeletal) patients by sending them to dance classes.”
NHS England, the Management Commissioning Board, has issued a Long-Term Plan. Social prescribing and community volunteer-led care are large elements. It’s spun as alternative healthcare but it’s really about finance, shrinking the NHS menu and transferring us to the USA Accountable Care Organisation model of care, which is based on insurance mechanisms.
So back to the first question. Where are the safeguards?
And what is really happening to the NHS?
Steven Carne is an actor, community filmmaker and chair of 999 Call for the NHS.