Speeches : Scottish Parliament

Social Prescribing

18 February 2020

The Health and Sport Committee’s view of social prescribing can be summed up by the subtitle of our report, which is “physical activity is an investment, not a cost”. That does not mean that it should be free—far from it. Our report is very clear that we must move beyond warm words on social prescribing and instead start spending some serious money on it. In the committee’s view, it would be money well spent—indeed, it would be money being better spent than current health and care expenditure, which needs to shift from the acute sector to the community sector, from cure to prevention, and from medical prescriptions to social prescriptions.

Social prescribing is, of course, about more than just physical activity. Many other areas of cultural, recreational and social activity bring similar benefits to health and wellbeing—some of which we will, no doubt, hear about in the course of the debate.

The committee’s report highlights the pre-budget scrutiny that has been undertaken by the Culture, Tourism, Europe and External Affairs Committee, which explored the benefits of social prescribing in the field of culture. As the Health and Sport Committee’s name suggests, it has a particular responsibility for focusing on the health benefits of sport and physical activity, which we do in our report. However, many of our conclusions on the benefits of physical activity for physical and mental health are just as true of the benefits of other social prescriptions, which we also commend to the minister and all who are concerned with delivery of health and care.

I thank all those who helped to make the committee’s report possible. We received nearly 100 written submissions, and many witnesses took part in our round-table evidence session. In addition, we have incorporated some of the evidence that we received in our inquiry into primary care, including that which was given by members of the public at the start and the end of that inquiry. Evidence that we have taken in pre-budget scrutiny and from individual health boards and integration authorities has also been included and has informed our report. As always, members of the committee are indebted to our committee clerks, and to Scottish Parliament information centre researchers and other parliamentary staff who have helped us with our work.

The Health and Sport Committee’s strategic plan for this session of Parliament committed us to seeking new ways of reducing inequality, of preventing illness and of promoting better health. We believe that social prescribing will play a critical part in our achieving those objectives. Our report sets out a case for improving access to all activities that make and keep our citizens well.

Prevention is key—indeed, it is better than cure. The committee has previously reported on the need for prevention to come first. It is surely self-evident that a successful preventative approach would make all the difference to individuals, and would allow the national health service and health and social care partnerships to make the best use of scarce resources. However, prevention needs investment. It also needs a fundamental shift in thinking: by definition, it needs to be proactive rather than reactive.

We want Scotland to embrace social prescribing as a key change in achieving the preventative approach, but we should not be afraid to learn from other places at the same time. Last year, the University of Leeds held the world’s first international social prescribing day, which celebrated good practice and promoted innovation. This year, that day will be held on 12 March and will be promoted by, among others, the College of Medicine and Integrated Health.

In 2018, a general practice in Thornton Heath, in the London Borough of Croydon, successfully piloted a community prescribing project that gave people access to boxing, bingo and Bollywood, among other activities. People who had previously been isolated started to interact in their communities, and to become more independent. Because of that pilot, visits to general practitioners for non-medical advice, outpatient referrals from GPs and emergency admissions to hospital have all gone down.

That is the direction that we want Scotland to take: the committee’s report sets out some of the actions that we need to take in order to get there. First, we need everyone concerned to accept our core message, which is that social prescribing of physical activity is an investment, not a cost. As the United Kingdom’s chief medical officer has put it,

“If physical activity were a drug, we would refer to it as a miracle cure, due to the great many illnesses it can prevent and help treat.”

Such activity improves not only physical health and wellbeing: our scrutiny also identified the positive impacts of physical activity on mental health. Further, we found that, in itself, participating can help to reduce social isolation and loneliness.

We focused on activities including table tennis, dancing and walking football, and we heard about new developments—we heard more about them at the committee’s meeting this morning—in walking netball and, prospectively, in walking rugby. We also recognise that volunteering, the arts, gardening, befriending and cookery classes can bring many of the same benefits.

Increasing physical activity and social interaction works and brings benefits across the spectrum of ages and circumstances, from school and pre-school children, through people of working age, to our most senior citizens. Participation in physical activity is good for primary prevention because it lays a foundation and creates resilience for later life. Physical activity can stop existing health problems from getting worse, help to reverse conditions such as type 2 diabetes and promote recovery and rehabilitation following medical treatment. It can enable people who leave hospital to self-manage their conditions in the community, it can help to prevent falls, and it can let people lead healthier lives for longer. It can also reduce reliance on pharmaceutical interventions—another area into which the committee is inquiring—and on access to unscheduled care.

Given all that, and given the body of evidence that supports all those statements, the committee is clear that the direct link between greater physical activity and better health has been proved beyond all doubt. It was therefore disappointing to hear that one of the obstacles to greater social prescribing is that there are still prescribers who do not accept that the link between physical activity and health is a matter of fact, who demand more evidence and who dispute the evidence that exists. Frankly, the committee thinks that such a belief is as unfounded in 2020 as denial of the reality of climate change or maintaining that the earth is flat are. All those who have professional responsibilities for other people’s health need to get behind the evidence and do everything that they can to support physical activity and social prescribing.

Given that physical activity is good, social prescribing is also good, because it is the crucial delivery mechanism for everyone who needs help to engage with physical activity. During our primary care inquiry, the Cabinet Secretary for Health and Sport noted that social prescribing makes a difference in improving health and wellbeing. She acknowledged that more awareness and understanding of its value are needed, and she highlighted that work is required to ensure that the right programmes and services are accessible to all who need them.

Jeane Freeman also accepted that, as things stand, not everyone has equal access to physical activity or to other social prescribing. Our inquiry found that active people are becoming more active, but we also found that the number of less active and inactive people is growing, and that many of those who are inactive, or less active than they should be for their health, live in our most deprived communities. The challenge, therefore, is one of equal access.

This morning, the committee heard about an example in Fife of social prescribing being offered. People can go to the doctor then get their medicine from the chemist for nothing, but people whose doctor prescribes a referral class might find that they need to pay for such classes every time they go. They might also have to pay for transport, childcare or other care costs to allow them to attend and participate in the activity. People in low-income households by definition struggle to meet such costs, so for that reason it is often easier and cheaper to rely on medications that are free to patients—albeit at a high cost to the NHS—but which might only address symptoms and not deal with the underlying causes.

Physical activity is an investment for people, their families and future generations. When individuals cannot afford to make that investment, it is surely up to the Government and the wider community to make that investment on behalf of us all. Processes need to be in place to make social prescribing easier, whether in primary care, secondary care or communities. Patients and prescribers need to understand the role of social prescribing, and technology and funding need to follow in order to make that happen. If medical and pharmaceutical prescriptions are important enough that we have free prescriptions, surely social prescriptions are of equal importance. Surely, social prescriptions must be equally available to the people who need them. That means that they need to be viewed, valued and funded on an equal basis with medical prescriptions.

Our report is clear that social prescribing is not a tool only for GPs in primary care, but should be deployed by a range of health and social care professionals and, ultimately, beyond the healthcare professions. That is one side of the equation. Making sure that activities are available also means that there must be organisations that are in a position to deliver them. Those organisations need funding and support in order to do the job, which means public investment in physical activity.

We have recommended in our report that at least 5 per cent of each integration authority’s budget should be spent on social prescribing, which means commissioning of local services. That investment should be focused above all on deprived areas and low-income households, in order to help to narrow the health inequality gap and to reduce future need.

We want conditions to be created in which people can flourish in their communities, wherever they live, and we want to close the growing inequality gap between active and inactive populations.

The potential to reduce pressure on our health and social care services alone makes the investment worth while, but the potential to improve the quality of life, health and wellbeing of individuals and communities makes it even greater and more valuable.

Health is the real wealth. In order to realise that wealth, we need to invest, because to do so will be to invest in the future health and wellbeing of our country’s citizens, and of our future generations, when we know that tough choices will need to be made as the population ages and as people live with increasingly complex needs.

We need to make the judgment now in order that we can get ahead of the curve: we need to make the investment early and support physical activity and other social activities that can maintain good health through a person’s life. The decisions must be made now, so that we see the benefits in the future.

We cannot simply say and agree that social prescribing is a good thing; we need to invest to ensure that it is delivered at scale across all health boards and integration authorities. That is the central challenge of the report for ministers and for public health professionals across Scotland. I hope that that challenge can be met.