Addressing inequalities with social prescribing

This summer, Andy Burnham, Greater Manchester Mayor, declared: “The truth is we have a political system that is inherently biased towards London and the devolved nations – and against Northern England. Until we all own up to that, nothing will change.” (The Guardian 22 Aug 2017) A fair point I might add.

The very next day the papers were hot with the cancellation of the Northern rail electrification scheme. We ‘in the North’ were told ‘the success of northern transport depends on the north itself ‘(Chris Grayling Yorkshire Post 27 Aug 2017). Steve Rotheram, Liverpool City Region Mayor, described this as an ‘abdication of responsibility’ and warned this would provide a catalyst for the North to ‘speak with one voice’. About time I would say. And you might just think, well bad things sometimes make good things happen, in that this political context is fuelling a real desire for greater collaboration and with this the opportunity for real empowerment and change.

But the North hasn’t been idle, behind the scenes, whilst our politicians have been laudably leading a heartfelt and important debate across the national press during the summer recess there has also been what I would describe as a quiet revolution in our NHS. Key people have been working quietly away to shift the focus from an illness agenda to encompass ‘a more than medicine’ approach to fight the very health inequalities which are helping to drive up demand. They have been using NHS leverage to drive wellness.

In 2015 Health Education England (HEE) working across the North West led a national strategy for widening participation in healthcare education IT Matters.

The subsequent HEE Widening Participation Directory of Best Practice drew together over 80 case studies which highlighted the need to:


  • develop and extend the talent pool on which the health sector can draw to support workforce planning
  •  support transition into employment for disadvantaged groups because this reduces attrition and turn over and drives down recruitment costs
  •  provide paid and voluntary work opportunity for those groups traditionally disadvantaged in the labour market, which improves people’s lives and reduces demand for support services as socio-economic advantage is shared
  • contribute to individual, organisational and societal wellbeing

Clearly what is good for people is also good for the NHS and vice versa.

On 18 May 2017 NHS Halton CCG launched the first NHS Cultural Manifesto for Wellbeing at the Kings Fund as part of the national conference: Social Prescribing from Rhetoric to Reality. The Halton manifesto laid out a firm commitment to sustaining our NHS and the values that underpin it. It contained a clear acknowledgement that some things just need to change, ’put simply to reorient activity through partnership with others to keep people well and help them not become sick’. It advocated the need to manage demand in a meaningful way with a focus on increased personal agency with access to an enhanced wellness toolkit. Above all else it seeks to humanise health by making patients people again.

The manifesto laid out Halton CCG’s commitment to ‘harnessing and harvesting the power of cultural interventions and know how.’ It stated, ‘We believe by focussing on four specific activity domains we can do more, better. By working collaboratively with experts across culture, the environment and sports sector; and harnessing social value agendas we will drive forward a 21st century approach to healthcare in Halton which others could follow.’

The manifesto embraced a broad geography too, drawing on commitments from rugby clubs, with a programme being led by Widnes Vikings, Halton CCG and the Cheshire and Merseyside Children’s and Women’s Services Vanguard, cutting across the full Super League and the M62 corridor. Together they declared they would ‘challenge loneliness, isolation and dementia’ and ‘build belonging’.

Halton’s manifesto was a direct response to the CCG’s commitment to address health inequalities. It reflected an increased understanding of the crippling impact of the wider determinants of health on local people. It embraced a commitment to innovation through ‘a more than medicine’ approach with social prescribing at its core and it served to underline the importance of a social value agenda in relation to the use of NHS leverage to drive equity and social mobility.

This was closely followed in July by the All Party Parliamentary Group for Arts Health and Wellbeing inquiry report Creative Health; the culmination of two years of extensive research and an impressive evidence base making a clear case as to the value of the arts for health. Lord Howarth of Newport stated unequivocally:

‘We are calling for an informed and open minded willingness to accept that the arts can make a significant contribution to addressing a number of the pressing issues faced by our

health and social care systems.’

The report made ten recommendations. I want to highlight No 8:

‘We recommend that the education of clinicians, public health specialists and other health and care professionals includes accredited modules on the evidence base and practical use of the arts for health and wellbeing outcomes. We also recommend that arts education institutions initiate undergraduate and postgraduate courses and professional development modules dedicated to the contribution of the arts to health and wellbeing.’

Meanwhile NHS England has been driving the development of a national social prescribing network and supporting an emerging infrastructure through the establishment of regional steering groups.  This work culminated with the launch of the North West social prescribing network with a conference in Liverpool on 28 September.

In August, the Department of Health launched their voluntary sector grants designed to target social prescribing schemes. A maximum grant of £300,000 over three years is available, but projects must have match funding from year 2, increasing to 100 per cent external funding after the end of the three years.

The aim of the programme is to promote equalities and reduce health inequalities by building the evidence base around good practice in social prescribing, sharing lessons and widening adoption of interventions with a proven track record. The deadline is noon on 21st November 2017. Full details can be found here.

There is an awful lot going on isn’t there and as Michael Marmot so eloquently pointed out:

‘Health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue.’

Which just goes to show, one’s locality doesn’t determine thinking or vision or any commitment to a Fairer Society. We are all in it together. We need to stand together to do what is right because reducing inequality is good for everyone.

Jo Ward

Change Maker


Posted by: Jo Ward, on: 29 September 2017