Social prescribing – the good, the bad and the destruction of jobs and the local economy

Social prescribing is part of a process of destroying jobs and the local economy, although  you would never have guessed this at the Calderdale Clinical Commissioning Group Governing Body meeting on Thursday 10th August.

The meeting started as usual with a “patient story” that allows the Clinical Commissioning Group to reassure themselves that they have a reason to get out of bed in the morning (a phrase that Clinical Commissioning Group officials used more than once in discussing this patient story).

This time the patient story was a video of patient testimonies to the Staying Well social prescribing scheme to tackle loneliness, which was rolled out in the Upper Calder Valley a few years ago.

Grateful patients testified to the value of art classes, trips and gardening in helping them with improved mental and physical health. They spoke of reduced isolation, diabetes problems, back and knee problems, depression and memory loss and help with bereavement and recovery from heart attack, stroke and cancer.

Paul Butcher, Calderdale Council’s Public Health Director, said it was very positive to see the video and there would be continued evaluation of the scheme to see if it has got the required return on significant investment.

It is obviously great that people are benefitting from these social activities. It is not so great that these social activities are now only available through social prescribing, because cuts to local authority budgets have closed down so many  public services that support people’s needs for care and social, recreational and adult education activities.

You can see why people are desperate to salvage some of those services from the wreckage – but it is the wrong solution.

The Council is using public health money to replace these services with far cheaper schemes run largely by voluntary organisations.

This is all part of the over-burdening of the NHS – whose funding is meant to be ring fenced – by leaching out its money through the back door to take over other public service functions that have been cut or destroyed.

The effect has been to transfer properly funded public services, that employed people in properly waged jobs with proper employee entitlements, to poorly funded, precarious third sector organisations that often rely on volunteer labour.

In this respect social prescribing is part of a process of destroying jobs and the local economy, setting it on a race to the bottom, and of destroying a vibrant, properly funded public service sector that caters for people’s social, educational and recreational needs, as well as their social care and mental health needs.

Since this race to the bottom and destruction of public services are associated with increased stress from precarious employment, social isolation and poverty, and stress is an acknowledged cause of ill health, when you look at the big picture, social prescribing worsens the very problems it aims to solve.

The real need is for solutions to the

“toxic combination of poor social policies and programmes, unfair economic arrangements and bad politics”

that the 2008 World Health Organisation Commission on social determinants of health identified.

Such solutions would involve stopping and reversing “austerity” economics, creating green jobs and properly funding social, adult educational and recreational and leisure services.

As Labonte´and Stuckler* have pointed out, there is a need for stronger labour and social protection legislation and reversing

“the current trajectory of informalisation of the world’s labour force which…is experienced as ‘precarious employment’ in HICs” [High Income Countries].

There is also a need to increase the social wage – what Labonte´ and Stuckler call

“Post-market redistribution” [ie] “public investments in the goods and services essential for health and social cohesion as well as direct income transfers.”

* Labonte´, Ronald. Stuckler, David (2016) The rise of neoliberalism: how bad economics imperils health and what to do about it. Journal of Epidemiology and Community Health Volume 70, Issue 3 http://dx.doi.org/10.1136/jech-2015-206295

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