Can Scotland make social prescribing work?

THE OSS has welcomed the Scottish Parliament’s report on ‘Social Prescribing’ and urged the government to act on its recommendations to invest five percent of the new Integrated Authority budget in physical activity and sport.

Recommendations to take social prescribing more seriously and consider investing in treatments other than drugs has won widespread backing across the political spectrum, with Conservative MSP Brian Whittle (see below) leading the recent parliamentary debate with strong words for government officials.

Professor Richard Davison – ‘Social Prescribing is an investment in health’.

Davison is similarly enthusiastic about the potential for social prescribing to make a significant difference to the physical and mental health and wellbeing of the Scottish population, particularly people in deprived areas. The former Scottish cycling champion and Professor of Exercise Physiology at University of West of Scotland, Davison is also a member of the Observatory’s Europe-wide Research Advisory Group. He contributed to the report produced by the Scottish Parliament’s Health and Sport Committee, and took part in the parliamentary round-table as an expert witness.

He stated: “It is very welcome that the report concluded that allocating some Integrated Authority (IA) budget (5%) towards supporting ‘Social Prescribing’ of sport and physical activity would represent a valuable investment in preventive medicine.

“It makes clear that this is not a cost-free option and there are significant challenges in scaling-up to achieve the expected benefits, but the report is also clear that the utilisation of sport and physical activity in the social prescribing context has the potential to have a significant impact on wellbeing and health.

“Ultimately, this could reduce the frequency and severity of several long-term conditions leading in a reduction in the costs associated with acute care and pharmacological interventions. Failure to tackle these significant medical conditions resulting from low levels of physical activity will result in unsustainable increases in healthcare costs.”

There is a growing global understanding that reducing funding in community sport in all guises only contributes to a wide range of physical and mental health and wellbeing problems, however, while many other European countries have started to reverse that trend and are seeing benefits from investing more in activity, investment in sport and leisure in Scotland continues a now decade-long decline with more local cuts and facility closures forecast as a result of this month’s government budget.

NHS England are committed to a nationwide ‘Social Prescribing’ programme, currently recruiting an additional 1,000 link workers in a bid to help nearly one million people access the activities that best suit them by 2024. In Scotland the social prescribing picture is varied and Davison acknowledged that implementation across Scotland is not without its challenges.

“One of the difficulties in scaling-up is that despite both primary research and case studies demonstrating the potential of social prescribing of sport and physical activity these are typically small scale, short duration and generally recruit the ‘worried well’,” he added.

Retired people enjoy gym activities as part of their rehabilitation

“There is a lack of research evidence on how to achieve long-term changes in physical activity behaviour of the hard-to-reach groups, which is needed to convince the medical establishment. A large proportion of participants within a social prescribing programme are likely to be in these harder to reach groups and these individuals often shun physical activity, do not see themselves as sporty and are reluctant to change current lifestyle behaviours.  This, ultimately, increases the resources required to successfully implement a social prescribing programme. Therefore, a challenge will be appropriately training sufficient numbers of staff to deliver the social prescribing programme.

“The next major challenge is scaling up the the outlets available to the Community Link Worker whether these are existing health services or other local external providers from, for example sporting organisations, leisure trusts or 3rd sector providers. While there is some activity from these providers funding and training will be required to grow the provision available to Link Workers. Many Sports Governing Bodies could potentially contribute expertise and facilities but this would represent a significant shift in expected outcomes set by Sportscotland.”

The OSS is working to provide more wide-ranging evidence and research analysis in this area. If you wish to contribute, get in touch: david@oss.scot.

Social Prescribing Report Recommendations

• Scottish Government recognises that this is not a cost-free option but that this investment in sport and physical activity will have a significant cost saving returns and thus allocates the recommended 5% of IA budget to this activity.

• An appropriate training programme in sport and physical activity is developed for Community Link Workers

• A comprehensive independent research/evaluation programme is commissioned to learn lessons on scaling-up and working with these difficult groups.

• Sports Governing Bodies receive funding linked to outcomes to assist delivery of the sport and physical activity prescription.

• Leisure Trusts should be supported to train staff and provide appropriate activities suitable for this kind of social prescribing.

• Third Sector organisations receive funding to develop and scale-up their current activity in this area.