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.
Having been a Director of Estates and Facilities in the NHS for 10 years of my 35+ service in the public sector, I found this article to be both refreshing and spot on. The NHS forgets why we exist - for people and build these mausoleums/monoliths that might win awards........but functionally are cold, sterile and focused on budget lines and ownership, rather than service delivery. I thought your warm description of success and why it does not repeat was spot on. Ultimately buildings are about supporting people and I would argue should be a servant to the people. Too often it is about ego's and status and as you rightly say a lack if investment at the commissioning stage and ongoing running costs
An excellent read - thank you
Social Prescribing needs more equality. We’re being funded by the NHS largely and doing the same job but employed by other organisations with different rates of pay and other benefits. A social prescriber employed by a District or Borough Council is infinitely better off with a local government pension than someone employed by a charity. A social prescriber who has no access to the NHS systems is doing a massive amount more admin - it’s feeling like a data entry job! Also, because GPs in our area are financially incentivised to refer, they are now sending hundreds of referrals which have been generated by data extraction without obtaining specific consent for referral which is shocking. The role needs to be standardised so that we’re all working under the same conditions with the support we’re entitled to.
I have served 2 terms on Salisbury District council and on the second term it was a Parish council, as the county council took over what little power the district had. Until local govnt is reformed and central politics has accepted that the 2 party system without proportional representation , as per the Electoral Reform Soc., is not fair and not working, the only other show, in proper cities, is the elected mayoral system. Coalition govnt is not less efficient as judged by GDP in Europe.
With regard to the NHS I believe state and private education need to include human studies so that each citizen has enough basic self care knowledge, and that the public should share the responsibility for self care, including an equal responsibility to clinicians for giving/getting informed consent to treatment. Finally government needs to be more open when informing voters about the NHS and Social care. Making buildings nicer for voluntary work is still necessary!