How can we adapt the NHS estate for social prescribing?

The original article was published on The King's Fund website - you can read it here.

Last week, The King’s Fund and NHS Property Services met the ‘dons’ of social prescribing – Sir Sam Everington, Arvind Madan, Alyson MacGregor, and other founders of the social prescribing movement in England. We discussed a recent paper from The King’s Fund, commissioned by NHS Property Services, on social prescribing and NHS facilities. And we asked how the NHS could accelerate the sort of transformation seen at Alvanley and other NHS services.

We started by presenting a puzzle or conundrum regarding the spread of good practice in the design and use of NHS facilities. For at least thirty years, there have been small pockets of excellence around England, for example the voluntary sector-led Bromley by Bow Centre in London, which brings together health services, other public services, voluntary organisations and local people to improve wellbeing. There are some excellent newer centres too, for example the Limelight Centre in Trafford, Greater Manchester. But overall public services have found it exceptionally difficult to replicate these fantastic models.

Attendees at our roundtable highlighted a range of rules, regulations and established approaches that make it difficult for NHS services to make good use of facilities with communities. Sir Sam Everington, Chair of Tower Hamlets Clinical Commissioning Group and a GP at the Bromley by Bow GP Partnership, highlighted how difficult it was for voluntary organisations to pay high rents to use NHS facilities. 

There was agreement that some of these rules and practices must change. But there was a sense that other cultural factors also need to be addressed. Sarah Wrigglesworth, a leading architect, compared the symbolism of ‘harsh, industrial’ NHS buildings with that of community-led centres like Bromley by Bow. She asked whether it was realistic to bring together health, wellbeing and community activities at NHS facilities, unless they first become more welcoming places for local people. Victoria Tzortziou Brown, Honorary Secretary of the Royal College of General Practitioners, also emphasised the importance of creating friendlier and healthier spaces.

The good news is that there is a lot the NHS can do to create a more welcoming environment. As Alyson MacGregor, Director of Altogether Better, explained, it can be hugely powerful just to take down some of the notices and put some children’s art on the walls. Mike Reeve, Director of Operations at the Social Enterprise NAViGO in North East Lincolnshire, highlighted the value of hiring service users, for example to run catering and maintenance services, as one of the ways of creating a culture of partnership with communities.

Arvind Madan, a director of the Hurley Group of GP practices, Dan Hopewell, the Director of Knowledge and Innovation at the Bromley by Bow Centre, and others highlighted the huge opportunity created by primary care networks and social prescribing link workers to trigger a step change in partnership working with communities. (Our recently updated explainer on social prescribing describes some of these changes.) As Dan put it, these initiatives create an opportunity to shift the dial from a system designed to treat illness to a system that works in partnership with communities to promote health and wellbeing. But this will require very different facilities and approaches to using facilities than we have at present.

For participants at our roundtable, the challenge now is to capitalise on this momentum and move more quickly and consistently to models that combine public services and community resources to support wellbeing. There was recognition that top-down, ‘lift and drop’ approaches to spreading good practice have not worked. But as Arvind Madan put it, neither can we just rely on a small number of charismatic individuals in the social prescribing movement to spread effective approaches. Our paper for NHS Property Services, attempts to clarify and share some of the core principles that underpin Bromley By Bow’s and other leading centres’ success, for example, their models of partnership working, the architectural and design features of their facilities their and commitment to genuine co-production with communities.