The Social Prescription We Need – Freedom

About 20 years ago, I worked with an older person called Florence. Florence was in her early 80s and had been known to social services for many years. Each November Florence would, much to the concern of her family and the plethora of community social workers, nurses and carers who supported her, take herself off by via a series of taxis, buses and National Express coaches for a two-week holiday in Skegness. She would stay at the same B&B, which she described as ‘lovely and empty’ and on her return from the holiday would describe how on each morning she would sit alone in the empty dining room and eat a full breakfast ‘in total peace’. Shewould describe the weather during the weeks as ‘bitter’ o me how quickly the town would become pitch black in the evening, well
before teatime, and that anything that was open during the day (which sounded like not a lot) would be closed by 4pm. Florence would always smile when describing the wind as ‘bracing’ and the waves as ‘rough as hell’, watching with delight as I would wince with each awful meteorological description she would regale me with. She would spend her days there either walking through Skegness, stopping at emptycafes to drink tea and read discarded newspapers or would use buses to travel
around the Lincolnshire coast, visiting other resorts that were equally closed down or at least very much out of season. One day she would go to Mabelthorpe, another day Ingoldmells and she always had a day in Cleethorpes – her highlight. It was Florence’s thing. It worried professionals and perplexed her family in equal measure. But she lived for it. She counted down the days to it. And when she returned it was abundantly clear to those around her – she had loved it.  

Now, maybe there are scores of older people who choose two weeks of relative isolation on the vibrant Lincolnshire coast each November and I am just unaware of them but it always struck me just how nuanced that holiday was. Very few of us would choose it. But crucially, when it comes to what makes people tick, it’s an example of how unique we are, how tailored our own particular needs are and how difficult it really is to prescribe a good time or an outcome or a service for someone else. Evidently, a cold, wet fortnight in Skeggy to some is a tropical island of Caribbean paradise to others.

I remembered Florence and her annual holidays a few weeks ago when I was attended an online discussion on Social Prescribing. The webinar speakers were clever and knew loads more about social prescribing than me and made a lot of sense. Most were talking about social prescribing in positive terms and there were some really lovely examples of where innovative stuff was happening and where ‘area coordinators’ and ‘connection leads’ had clearly made a difference through social prescribing. My experience with social prescribing up to that point had been
limited. I do recall working with a GP practice during a ‘vanguard pilot’ (vanguard?! It’s no wonder they failed!) who had linked with the local Bowling Club. I remember the Practice Lead jauntily telling us that their ambition was for ‘bowling on prescription, rather than anti-depressants’. That line alone, dripping in good intentions no doubt, was enough to put me off social prescribing for life. I remember another person at the event talking about the joy of ‘men in sheds’. A brilliant resource for the right person no doubt and I mean the scheme no disparity at all but the thought of sheds filled with other men ‘prescribed’ to me in a well-meaning effort to assist me with whatever social gap I had left me as cold as one of Florence’s morning walks in Skeggy. That said, I might consider joining a group called Men Avoiding Sheds.

Anyway, talk of social prescribing led to me looking online again to see if things had moved on any. The first site that comes up on social prescribing is the NHS website. Only about a paragraph in and you come across words like General Practice, pharmacies, multi-disciplinary teams, hospital discharge, allied health professionals, complex care needs and ultimately of course, service users and patients. Further reading of the NHS website on the wonders of social prescribing explains how essential a ‘link worker’ is and that they take a ‘what matters to me approach’ before ‘connecting people to community groups and statutory services’. Now, it might just
be me but isn’t that a huge contradiction? Its saying that the assessment is person centred (what matters to me) but the outcome (or is it the prescription?) is connecting people with ‘community groups and statutory services’ – whatever best fits. It’s the classic Henry Ford quote that ‘any customer can have a car painted any colour that he wants, so long as its black’. There appears to be no room for the ‘what matters to me approach’ concluding that ‘the very last thing I ever want is a community group or statutory services thanks very much’. I’m getting visions of being put in a shed with men I don’t want to be with again!

So it strikes me that whilst we might have some good intentions around social prescribing, we seem to still be significantly missing the point of personalisation (are we still allowed to say the P word?). We’ve largely missed the point in Local Authorities and now we are missing the point in the NHS. The state, preoccupied with itself and the assessment, the prescription, the link worker and its godforsaken Mary Poppins bag of tricks approach to services to suit all needs, fundamentally misses the point of our uniqueness, quirkiness, deep rooted personal wants that cannot ever be reimagined for us by people paid to momentarily know us and assess
and prescribe for us. The choices people make, including things as outlandish as Skegness in November for Florence or a fortnight watching Newell’s Old Boys football matches in Rosaria in Argentina and hoping for a glimpse of Marcelo Bielsa (my choice), are so nuanced and personal that they cannot ever really be prescribed.

I get I am part of the problem. Me, our sort, us and our organisations. As a link worker or a social worker or anyone else who is administering the process, we don’t come into the assessment conversation from a neutral perspective. Whether we are browbeaten into assessing the bear minimum for people for fear of exceeding budgets and worrying the financial stability of the organisations who employ us, whether we think assessing is or is not a primary function of social work or whether we have made a career churning out the usual erroneous stock answers to people’s presenting circumstances via day care, home care, respite or permanent care, the apparatus of the state is so badly placed to understand genuine uniqueness and personalisation. The government is probably the last people that should be doing this stuff because crucially, we are not neutral.

The very best social assessor that anyone can have is themselves – by at least a million miles. And the best support to the person who cannot articulate their own personal, quirky, uniquely tailored social care outcomes? That’s more likely to be family and friends than anyone else, although not always of course. In my experience paid support such as link workers, social workers and other professionals are at the bottom of the list of people who make this stuff work well because we are not neutral, we do not have allocated time nor the love for the personto ever get close to someones uniqueness. And the process ensures we will (as the NHS website clearly tells us) jump seamlessly from a ‘what works for you approach’ to a ‘here’s a list of community groups and statutory services for you’ in a nanosecond if it helps us deal with volume and service the
industry. That isn’t to say the state doesn’t have a role to play – it does. As always the role must be in trying to ensure the right environment so that people exercise their rights and not our processes.

Social assessing and prescribing, whether it’s day care with fake shopping trips, bowling clubs linked to GPs, exercise classes, walking clubs, links to social clubs or other well intended affairs, are probably genuine attempts to aim in the right direction but they are steeped in all the biases, pressures and expectations that are inherent in the state. But surely only I can socially prescribe for me what I need in the same way that only Florence?

Perhaps the best we can do with is prescribe to the fact that people are the experts of their own lives and our role is to help them and their families properly meet the individual outcomes that suit and deliver them from the
burden of bureaucracy, suspicion and in some cases outright and open hostility when they attempt to take this on. The support we can give to people is to broker a helpful, friendly, grateful and trusting environment between themselves and the state so they too may find their own unique version of two weeks of cold in late autumnal Skegness.