Social prescribing in ACES

The original article was pubulished in ACES, you can read it here: 2021-Spring-Terrier3.pdf (aces.org.uk).

The NHS Long Term Plan includes a focus on helping people stay healthier for longer and supporting community activities that help improve people’s wellbeing; otherwise known as social prescribing. The theory behind social prescribing is that the fitter, healthier and more socially connected people are, the less likely it is that they will need to access local GPs or other health professionals. Social prescribing enables GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services to support their health and wellbeing, including activities such as gardening, cooking or art classes. This is something that members of the public want too, with a survey undertaken by NHS Property Services (NHSPS) revealing that nearly one fifth of respondents want access to additional community services such as support groups, exercise classes or nutrition programmes**. The NHS is therefore developing social prescribing networks across the country, and at NHSPS we are transforming sites to help facilitate these, in order to bring health and social care together to address the wider determinants of health and wellbeing. In turn, this will hopefully help reduce the pressure on NHS services and address some of the challenges that local authorities are facing.

In practice, supporting social prescribing initiatives that improve community wellbeing can be as simple as turning a small outdoor space into an allotment, allocating kitchen space to a weekly evening cooking class or giving a charity access to unused space to run a food bank. A recent report that we conducted with The King’s Fund revealed how, instead of focusing on major new projects, smaller transformations can make lasting and impactful change on communities. The report - Social Prescribing and NHS Facilities – recommends creating welcoming environments for people to carry out a broader range of activities in and around their current healthcare facility. It also highlights the need to make it practically easier for communities to use local facilities, enabling us to create more vibrant social prescribing hubs, by removing bureaucratic rules which, for example, only grant access to facilities on an exceptional basis and contractual agreements and requirements that prevent changes to facilities, however small, to be approved by a contractor.

Across the country, spaces are being adapted to address local health and social needs for little to no cost. It is easier than people think, and there are many examples, including one of our sites in Scunthorpe where the reception area is being reorganised and the café improved, creating space and a more welcoming environment simultaneously. In addition to this, in Tyne and Wear, an overgrown plot of land next to the Houghton Primary Care Centre has been transformed into a beautiful community garden. Following the creation of the garden, we partnered with the nearby Sunderland Recovery College who now oversee the garden and run courses there for people recovering from mental health problems. People from the local community have also started coming back to the space and are helping to maintain the garden and grow food for the community.

There are also bigger scale projects such as an onsite kitchen refurbishment at Axminster Community Hospital, which is now used by a local charity running cooking classes, meals on wheels and re-enablement services. At Hunter Street Medical Centre in North London, a unit has been refurbished to create six listening rooms for the charity The Listening Place, which will use the space to support more people within the capital and, importantly, will allow them to still socially distance while being able to speak with people face to face. In Rotherham, a site is being fully refurbished to make the space functional for community groups.

It’s not just the NHS that is seizing this opportunity. There are hundreds of examples of local authorities making community environments more welcoming and helping residents to feel like the space is theirs. It is important that local authorities continue to utilise their assets to help improve the wellbeing of the community.

Asset Managers within public sector organisations hold the key to unlocking the therapeutic potential of social prescribing in their communities. By providing space on a flexible basis, and utilising tenancy at will or licences, rather than traditional leases, community groups will be encouraged to make use of the space. Consideration towards reducing the rent to below market value, or even to a nil basis, will help support charitable organisations to run their services from the buildings, and the potentially increased foot-flow to libraries, townhalls, or leisure centres will have additional benefits that will offset a rental income.

By way of example, we hold a head lease of a community health centre, within which there is 128m2 of shell space. Our teams worked with a local voluntary sector organisation to develop a proposal to turn the space into a self-contained unit – with its own entrance, kitchenette and toilet facilities. The cost of the fit-out is being funded using NHSPS capital and the space will be let to a single voluntary sector organisation on a tenancy at will at nil cost. We will cover the facilities management costs of the space, so that the space is “free” for the voluntary organisation to use. The voluntary organisation will then manage the space on a daily basis, ensuring it is made available to social prescribing groups that deliver the services identified as being required in that locality. The occupation of the space is on a “sharing” basis and no landlord and tenant arrangement has been created, thus avoiding breach of the head lease provisions. The rent attributable to the space is already counted by NHSPS as an unrecoverable sum and therefore there is no change to the accounting arrangements.

Now more than ever it is important to not only understand the needs of the community but to also ensure that these needs are met. Local facilities like libraries or community gardens are so much more than just spaces; they are community assets that can help people feel connected with their community and improve their wellbeing. As the new financial year begins and the end of the pandemic is in sight, people will need support from their communities to recover from the aftermath of COVID-19. Together, we will tackle and overcome the health crisis that we are facing.

*Nick O’Shea (October 2020). Covid-19 and the nation’s mental health: October 2020. Available at: https://www.centreformentalhealth.org.uk/publications/covid-19-and-nations-mental-health-october-2020 [Last accessed: March 2021]

**Figures from YouGov Plc. Total sample size was 2014 adults. Fieldwork was undertaken between 17th - 20th July 2020. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).