Cllr Michelle Lowe contested Coventry South at the General Election last year, and is Deputy Leader and Cabinet Member for Housing & Health at Sevenoaks District Council.
With people living longer, and more of us living with more than one complex condition, combined with more expensive treatments available – the NHS constantly needs more resources. Only in the last year, Theresa May promised a further settlement of an extra £350 million a week – an increase of three per cent a year.
The NHS has been so successful at making people better after they have become ill that as a society we have forgotten how to prevent people from growing ill in the first place. During Victorian England it was not the health service that eradicated Cholera, but local government by dealing with the causes of the illness: cleaning up the water supply and tackling overcrowding in poor quality housing. Local government needs to return to its prevention roots and promote wellbeing, thereby reducing demand on the NHS.
Local government is starting to do just that. By introducing a health-in-all-policies approach to everything it does, councils can use planning, housing policy, environmental health, leisure, licensing etc to create healthy local environments. But local government can and is going further with social prescribing initiatives to support the NHS. Social prescribing helps to reduce hospital and GP appointments and tackles the underlying non-medical reasons that people seek medical help such as asthma caused by damp housing, anxiety caused by debt, and a range of conditions caused by loneliness, poor diet, and lack of exercise.
Often social prescribers are based at GP surgeries and have more time to discuss with people what could be causing an issue such as anxiety. They can then refer them to the relevant agencies that can help them. It makes more sense to help them with the cause then to keep prescribing medicines that are only masking the problem. Social prescribers can link patients into the services that can help with their problem: debt advice, private sector housing to tackle damp, voluntary activities or opportunities to tackle loneliness etc.
Every GP has at least four appointments each day from people that are lonely; and loneliness is as bad for our health as smoking 15 cigarettes a day; so these services make a big difference. Often they can be run in conjunction with housing associations and the voluntary sector such as Age UK, having the double whammy of supporting charities and other local volunteering groups.
Social prescribing can look after people holistically. Falls prevention classes for older people can take place in an indoor environment providing exercises or chair yoga; or can be gentle walks through a park or the countryside. They nearly always end with a cup of tea and a chat with more advice about fuel efficiency, internet scams, and other issues concerning older people – while combating loneliness. By linking the social prescriber with housing providers many of these activities can take place in retirement villages open to nearby residents – helping to create stronger communities.
Nearly half of all falls occur at home so falls prevention classes combined with home adaptations and using the planning process to build more supported housing across all sectors can help older people live more independently and out of hospital. Given that older people can lose up to five per cent of their muscle mass each day they stay in hospital it vital for their chances of remaining independent at home they are not admitted to hospital at all. Age UK estimate that falls in the over 65s cost the NHS £4.6 million a day – so this work really can make a difference.
For those who are admitted to hospital, many councils are using the Better Care Fund to adapt their homes while they are in hospital so they can be discharged as soon as they are clinically ready. It could be something simple such as moving a bed from upstairs to downstairs or fitting a key safe so carers can gain access to the home, to something more complicated such as ramps and rails. As a result despite last winter being one of the coldest on record many hospitals met their discharge times.
Missed GP appointments are estimated to cost the NHS £216 million a year. Sevenoaks District Council employ a number of “One You” Social Prescribers who contact people who regularly miss appointments to find out why and help to rectify the situation. Some stories are very sad. One man was blind and unable to record his appointment times. By contacting the RNIB technology was fitted in his home that enabled him to keep track of his diary commitments – completely revolutionising his life for the better. This story to me sums up the true value of social prescribing.
The role of local government is critical in helping people live healthier, more independent lives, taking the pressure off the NHS and indirectly social care. The new, recently published, NHS 10 year plan recognises the role of prevention and local government. When the new Health and Social Care Green Paper is published it will be great if that builds on the work of local government and supports this trend. There is no one way to keep people well and reduce demand on the NHS; but local government has a number of tools at its disposal that can help to make a big impact.