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Social Prescribing

– in the Scottish Parliament on 18th February 2020.

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Photo of Kenneth Macintosh Kenneth Macintosh Labour

The next item of business is a debate on motion S5M-20753, in the name of Lewis Macdonald, on the Health and Sport Committee’s report “Social Prescribing: physical activity is an investment, not a cost”.

Photo of Lewis Macdonald Lewis Macdonald Labour

The Health and Sport Committee’s view of social prescribing can be summed up by the subtitle of our report, which is “physical activity is an investment, not a cost”. That does not mean that it should be free—far from it. Our report is very clear that we must move beyond warm words on social prescribing and instead start spending some serious money on it.

In the committee’s view, it would be money well spent—indeed, it would be money being better spent than current health and care expenditure, which needs to shift from the acute sector to the community sector, from cure to prevention, and from medical prescriptions to social prescriptions.

Social prescribing is, of course, about more than just physical activity. Many other areas of cultural, recreational and social activity bring similar benefits to health and wellbeing—some of which we will, no doubt, hear about in the course of the debate.

The committee’s report highlights the pre-budget scrutiny that has been undertaken by the Culture, Tourism, Europe and External Affairs Committee, which explored the benefits of social prescribing in the field of culture. As the Health and Sport Committee’s name suggests, it has a particular responsibility for focusing on the health benefits of sport and physical activity, which we do in our report. However, many of our conclusions on the benefits of physical activity for physical and mental health are just as true of the benefits of other social prescriptions, which we also commend to the minister and all who are concerned with delivery of health and care.

I thank all those who helped to make the committee’s report possible. We received nearly 100 written submissions, and many witnesses took part in our round-table evidence session. In addition, we have incorporated some of the evidence that we received in our inquiry into primary care, including that which was given by members of the public at the start and the end of that inquiry. Evidence that we have taken in pre-budget scrutiny and from individual health boards and integration authorities has also been included and has informed our report. As always, members of the committee are indebted to our committee clerks, and to Scottish Parliament information centre researchers and other parliamentary staff who have helped us with our work.

The Health and Sport Committee’s strategic plan for this session of Parliament committed us to seeking new ways of reducing inequality, of preventing illness and of promoting better health. We believe that social prescribing will play a critical part in our achieving those objectives. Our report sets out a case for improving access to all activities that make and keep our citizens well.

Prevention is key—indeed, it is better than cure. The committee has previously reported on the need for prevention to come first. It is surely self-evident that a successful preventative approach would make all the difference to individuals, and would allow the national health service and health and social care partnerships to make the best use of scarce resources. However, prevention needs investment. It also needs a fundamental shift in thinking: by definition, it needs to be proactive rather than reactive.

We want Scotland to embrace social prescribing as a key change in achieving the preventative approach, but we should not be afraid to learn from other places at the same time. Last year, the University of Leeds held the world’s first international social prescribing day, which celebrated good practice and promoted innovation. This year, that day will be held on 12 March and will be promoted by, among others, the College of Medicine and Integrated Health.

In 2018, a general practice in Thornton Heath, in the London Borough of Croydon, successfully piloted a community prescribing project that gave people access to boxing, bingo and Bollywood, among other activities. People who had previously been isolated started to interact in their communities, and to become more independent. Because of that pilot, visits to general practitioners for non-medical advice, outpatient referrals from GPs and emergency admissions to hospital have all gone down.

That is the direction that we want Scotland to take: the committee’s report sets out some of the actions that we need to take in order to get there. First, we need everyone concerned to accept our core message, which is that social prescribing of physical activity is an investment, not a cost. As the United Kingdom’s chief medical officer has put it,

“If physical activity were a drug, we would refer to it as a miracle cure, due to the great many illnesses it can prevent and help treat.”

Such activity improves not only physical health and wellbeing: our scrutiny also identified the positive impacts of physical activity on mental health. Further, we found that, in itself, participating can help to reduce social isolation and loneliness.

We focused on activities including table tennis, dancing and walking football, and we heard about new developments—we heard more about them at the committee’s meeting this morning—in walking netball and, prospectively, in walking rugby. We also recognise that volunteering, the arts, gardening, befriending and cookery classes can bring many of the same benefits.

Increasing physical activity and social interaction works and brings benefits across the spectrum of ages and circumstances, from school and pre-school children, through people of working age, to our most senior citizens. Participation in physical activity is good for primary prevention because it lays a foundation and creates resilience for later life. Physical activity can stop existing health problems from getting worse, help to reverse conditions such as type 2 diabetes and promote recovery and rehabilitation following medical treatment. It can enable people who leave hospital to self-manage their conditions in the community, it can help to prevent falls, and it can let people lead healthier lives for longer. It can also reduce reliance on pharmaceutical interventions—another area into which the committee is inquiring—and on access to unscheduled care.

Given all that, and given the body of evidence that supports all those statements, the committee is clear that the direct link between greater physical activity and better health has been proved beyond all doubt. It was therefore disappointing to hear that one of the obstacles to greater social prescribing is that there are still prescribers who do not accept that the link between physical activity and health is a matter of fact, who demand more evidence and who dispute the evidence that exists. Frankly, the committee thinks that such a belief is as unfounded in 2020 as denial of the reality of climate change or maintaining that the earth is flat are. All those who have professional responsibilities for other people’s health need to get behind the evidence and do everything that they can to support physical activity and social prescribing.

Given that physical activity is good, social prescribing is also good, because it is the crucial delivery mechanism for everyone who needs help to engage with physical activity. During our primary care inquiry, the Cabinet Secretary for Health and Sport noted that social prescribing makes a difference in improving health and wellbeing. She acknowledged that more awareness and understanding of its value are needed, and she highlighted that work is required to ensure that the right programmes and services are accessible to all who need them.

Jeane Freeman also accepted that, as things stand, not everyone has equal access to physical activity or to other social prescribing. Our inquiry found that active people are becoming more active, but we also found that the number of less active and inactive people is growing, and that many of those who are inactive, or less active than they should be for their health, live in our most deprived communities. The challenge, therefore, is one of equal access.

This morning, the committee heard about an example in Fife of social prescribing being offered. People can go to the doctor then get their medicine from the chemist for nothing, but people whose doctor prescribes a referral class might find that they need to pay for such classes every time they go. They might also have to pay for transport, childcare or other care costs to allow them to attend and participate in the activity. People in low-income households by definition struggle to meet such costs, so for that reason it is often easier and cheaper to rely on medications that are free to patients—albeit at a high cost to the NHS—but which might only address symptoms and not deal with the underlying causes.

Physical activity is an investment for people, their families and future generations. When individuals cannot afford to make that investment, it is surely up to the Government and the wider community to make that investment on behalf of us all. Processes need to be in place to make social prescribing easier, whether in primary care, secondary care or communities. Patients and prescribers need to understand the role of social prescribing, and technology and funding need to follow in order to make that happen. If medical and pharmaceutical prescriptions are important enough that we have free prescriptions, surely social prescriptions are of equal importance. Surely, social prescriptions must be equally available to the people who need them. That means that they need to be viewed, valued and funded on an equal basis with medical prescriptions.

Our report is clear that social prescribing is not a tool only for GPs in primary care, but should be deployed by a range of health and social care professionals and, ultimately, beyond the healthcare professions. That is one side of the equation. Making sure that activities are available also means that there must be organisations that are in a position to deliver them. Those organisations need funding and support in order to do the job, which means public investment in physical activity.

We have recommended in our report that at least 5 per cent of each integration authority’s budget should be spent on social prescribing, which means commissioning of local services. That investment should be focused above all on deprived areas and low-income households, in order to help to narrow the health inequality gap and to reduce future need.

We want conditions to be created in which people can flourish in their communities, wherever they live, and we want to close the growing inequality gap between active and inactive populations.

The potential to reduce pressure on our health and social care services alone makes the investment worth while, but the potential to improve the quality of life, health and wellbeing of individuals and communities makes it even greater and more valuable.

Health is the real wealth. In order to realise that wealth, we need to invest, because to do so will be to invest in the future health and wellbeing of our country’s citizens, and of our future generations, when we know that tough choices will need to be made as the population ages and as people live with increasingly complex needs.

We need to make the judgment now in order that we can get ahead of the curve: we need to make the investment early and support physical activity and other social activities that can maintain good health through a person’s life. The decisions must be made now, so that we see the benefits in the future.

We cannot simply say and agree that social prescribing is a good thing; we need to invest to ensure that it is delivered at scale across all health boards and integration authorities. That is the central challenge of the report for ministers and for public health professionals across Scotland. I hope that that challenge can be met.

I move,

That the Parliament notes the conclusions and recommendations contained in the Health and Sport Committee’s 14th Report 2019 (Session 5),

Social Prescribing: physical activity is an investment, not a cost

(SP Paper 639).

Photo of Joe FitzPatrick Joe FitzPatrick Scottish National Party

I thank the convener for setting out the key points from the Health and Sport Committee’s report on the social prescribing of physical activity and sport. I also thank all committee members for their work on the inquiry and for the opportunity to discuss the topic today.

Social prescribing is a valuable approach that can enable people and communities to take more control of their health and wellbeing. I welcome the committee’s constructive and wide-ranging report,

Today, I will focus on two main themes from the report. The first theme is the importance of physical activity and sport for our physical and mental wellbeing and how we can ensure that everyone in Scotland experiences those benefits. The second theme is how the healthcare system can raise awareness of the benefits of being physically active and can connect people so that they can be supported and get opportunities to be physically active.

The committee has focused on physical activity and sport in its inquiry. As the convener mentioned, there are, of course, other activities that can help people to improve their physical and mental health. I will spend a little time on that point later.

As the committee highlights throughout its report, there is no shortage of evidence on the benefits of physical activity and sport for our physical and mental health. The benefits include reducing the risk of heart disease, stroke, diabetes, many types of cancer and depression. The flipside is that physical inactivity damages our physical and mental health, which puts additional pressure on our healthcare system. I therefore agree entirely with the committee’s overall conclusion that physical activity should be seen as an investment.

This Government is committed to making that investment in physical activity and sport. In the current financial year, we have increased the sportscotland budget to £32.65 million, with similar levels of funding proposed in our recently published draft budget. In 2018, we doubled the active travel budget from £40 million to £80 million, and in our draft budget, we have set out plans to increase that again, to more than £85 million.

Together with partners across health, sport, transport, education, the environment and other sectors, we are taking concrete action to achieve our shared vision of a Scotland where people are more active, more often. “A More Active Scotland: Scotland’s Physical Activity Delivery Plan” demonstrates the breadth of those efforts. The World Health Organization has welcomed the plan’s systems-based approach to working across sectors and has recognised Scotland as one of the forerunner countries in responding to its global action plan on physical activity.

The committee is right to highlight the importance of addressing inequalities between the most and least-deprived areas in relation to participation in physical activity and sport. We all know only too well how challenging it is to tackle health inequalities and, equally, how vital it is that we spare no effort in doing so.

Sport has a major role to play in tackling inequality and contributing to a more inclusive Scotland. Through sportscotland, we are working to achieve that through a number of our main delivery programmes. For example, sportscotland’s active schools programme provides free or low-cost opportunities for children and young people to be active. An independent evaluation of sportscotland’s work in the schools and education environment, published in 2018, found that

“schools with high levels of deprivation were more likely to have high levels of Active Schools participation than those with medium or low levels of deprivation.”

That is an encouraging sign of success, given the inequalities that are experienced in many other sport and physical activity programmes.

Photo of Brian Whittle Brian Whittle Conservative

On that specific point, does the uptake of active schools participation in areas of high deprivation not highlight that schools those areas have very little opportunity to participate and that they will grasp any opportunity that is available to them?

Photo of Joe FitzPatrick Joe FitzPatrick Scottish National Party

No: it highlights the fact that all our agencies, and sportscotland in particular, are focusing their efforts. I will come to a few examples of where that focused effort tries to break down the barriers that we all know exist. There is no point in our pretending that those barriers do not exist—they do. From the figures, we can see a disparity in relation to physical activity between the most and least-deprived areas. That is why we need that focused action, and sportscotland, along with our education colleagues, is absolutely taking that action.

Sportscotland also works with partners to improve the provision, reach and community engagement of our community sport hubs in deprived areas, and its sport facilities fund gives priority to projects that provide more and better opportunities for underrepresented groups.

We also continue to invest in walking as a highly effective way of creating opportunities for everyone in Scotland to be active. Walking is an accessible, popular and cost-free activity, and we provide £1.2 million annually to Paths for All to deliver our national walking strategy. However, there is a long way to go if we are to see a reduction in inequalities in physical activity levels across the Scottish population as a whole. That must remain an on-going focus in our policies and in delivery.

The second area that I want to focus on is the role of the healthcare system in highlighting to people the benefits of being physically active, and in connecting them with the support and opportunities that they need to be physically active.

The committee has recommended that we support NHS boards and integration authorities to raise awareness of social prescribing and other activities around promoting physical activity, and that is what NHS Health Scotland works to achieve by embedding its national physical activity pathway in existing practice. The pathway is an evidence-based approach through which health and social care professionals can deliver structured, brief advice on physical activity.

NHS Health Scotland also works with academic partners and physical activity providers to develop quality standards for physical activity referral, which will lead to greater quality and consistency in the design and delivery of referral schemes in Scotland.

The committee’s report describes social prescribing as

“a way for primary care professionals to connect people to a range of local, non-clinical services.”

Those services are

“sources of support or resources in a local community that have the potential to help people with the health problems they are experiencing.”

I have spoken about the benefits of physical activity and sport, but it is important to recognise that other types of support and resources within local communities also have significant and proven benefits for physical and mental health. As the convener said, taking part in cultural activity—whether doing or seeing culture—has been shown to reduce social isolation, strengthen social networks, increase self-confidence and resilience and empower individuals and communities. Culture can and does play a key role in maintaining good mental health and wellbeing.

It is important that we recognise the range of activities that improve our physical and mental health and provide people with the options and support that best fit their own needs, interests and circumstances. That is very much in line with the principles of realistic medicine, which is all about supporting our healthcare professionals to deliver a more personalised approach to care. Social prescribing clearly has an important role to play in delivering that personalised approach, and we will explore that further by discussing with key stakeholders, including the Academy of Medical Royal Colleges, how Scotland might achieve that aim. We are also engaging with a number of expert by experience groups to capture their views.

Nevertheless, it is important to recognise that medical prescribing and social prescribing need not be mutually exclusive. In practice, a mixture of interventions might be appropriate for an individual’s personal circumstances. Rather than seek to trade one off against the other, it might be better to contrast health interventions that are done to people with a personalised approach, where they are done by people.

Increased resources are being allocated to building capacity and expertise in the healthcare system to enable that person-centred support. That includes our commitment to increasing the number of community link workers by 250 by the end of this session of Parliament. Community link workers play a key role in supporting patients to access local services. By the very nature of their role, they help break down the barriers that people face in taking part in physical activity and sport and in accessing other opportunities to improve their health and wellbeing in their local communities.

Similarly, our commitment in the mental health strategy to fund 800 additional mental health workers ensures that local provision and support are at the heart of our plans. Investing in the relationships between healthcare professionals and services or programmes in the community provides benefit in both directions. For example, as part of the Scottish Government’s work with the British Heart Foundation on blood pressure management, NHS Lanarkshire and NHS Western Isles have focused on identifying patients through community services. In Lanarkshire, that was done through leisure and cultural services delivering a programme of blood pressure testing as part of the expansion of physical activity prescription referral inductions. In the Western Isles, staff from the community carers forum delivered blood pressure testing to carers. Both methods supported a move towards prevention through simple-to-use digital technologies, away from the normal GP practice setting.

I emphasise that there are huge benefits to be gained from strong connections between healthcare practitioners and the voluntary and community organisations that provide the opportunity for people to improve their health and wellbeing within their local communities. Social prescribing is all about realising those benefits. Nevertheless, the committee is right to highlight that we must be mindful of the capacity and capability of the third sector to respond to additional demand through social prescribing. It is vital that we nurture the commitment to the health and wellbeing of people in Scotland of healthcare professionals and those who provide opportunities for people to take part in health-promoting activities in their local communities.

I look forward to hearing the thoughts of members from across the chamber on how we can best support people in those roles and make the most of the potential of social prescribing approaches to improve our physical and mental wellbeing.

Photo of Brian Whittle Brian Whittle Conservative

I could wax lyrical and extol the virtues of social prescribing—as most members will, I am sure. I am delighted to open the debate on behalf of the Scottish Conservatives, because, as members will know, it is on a topic that I am extremely passionate about.

As we have heard, the Health and Sport Committee conducted an inquiry into the social prescribing of sport, exercise and physical activity. At the end of the evidence session, we went into private session to discuss what we had learned. We all agreed that it was a very good session, with excellent evidence from an invited panel of experts. However, it is fair to say that our understanding of the topic grew by a grand total of zero. Who knew that social interaction and physical activity would be good for our health? That knowledge is hardly a breakthrough. We also discussed how many conditions are routinely medicalised when an alternative approach could lead to a better outcome in both physical and mental health. Again, that is hardly a revelation, although that approach will dovetail nicely with the work that we are currently doing on medicines. I am prepared to stick my neck out and predict that we will conclude that patients are being overprescribed medications when alternatives or a combination of medicines and activity would produce better results.

Presiding Officer, perceptive as you are, you might detect a hint of frustration—and you would be right. We have been discussing the desire to shift to a preventative approach since I entered the Parliament, nearly four years ago. I entered with such hope and, as it transpires, such naivety. There I was, thinking that in this place, among all the political posturing and wrangling, we might be able to make things a little bit better for people in Scotland. The reality is that, in that time, nothing of any note has changed save the relentless increase in the cost of preventable conditions. I am thinking of conditions such as type 2 diabetes, a recent report on which suggested that the number of people in Scotland with the condition—which is preventable for the most part or, at the very least, manageable—continues to increase. Type 2 diabetes and related complications already account for more than 10 per cent of the NHS budget, and that does not take into account the loss of productivity.

We are all aware of the huge rise in poor mental health, and evidence from both the Health and Sport Committee and the Public Petitions Committee highlights overprescribing of medication and a lack of access to alternative social solutions. In its submissions, the Scottish Association for Mental Health highlights its strong evidence-led belief that physical activity is a major contributor to a more stable mental state. I agree with the convener of the cross-party group on culture, Joan McAlpine, that the list of socially prescribed alternatives goes wider than sport and could be of significant benefit to those who suffer. There is music, for example, but—wait a minute—access to free music in schools has been cut.

As the convener of the cross-party group on arthritis and musculoskeletal conditions, I confirm that we are about to undertake a piece of work highlighting the need for better access to better self-management options, appropriate physical activity being key. The list goes on.

The keys to making social prescribing successful are as follows. Access to activity has been highlighted by the Health and Sport Committee’s convener, who rightly said that, if someone opts for medication, they can get a medical prescription that will cost them nothing, whereas, if they are socially prescribed something, the chances are that it will cost them money. There is space for a little bit of creativity. Instead of spending the money on medicine, we could spend the same amount on social prescribing—because there is a problem in accessing physical activity and travelling to physical activity, as Lewis Macdonald said.

The closing of council facilities, predominantly in rural and poorer areas, is a major contributing factor to inequality. Healthcare professionals need to understand what is on offer in the community. Evidence that was given today as part of the committee’s medicines inquiry strongly suggests that most GPs are unsure of what is available in communities as a possible alternative to medicalising a condition. We also heard that they need time to offer social prescribing, even if they are aware of the alternatives that exist.

The briefing from Barnardo’s Scotland suggests that the inclusion of children and young people in the committee’s investigation would have added weight to its conclusions, and I agree with that. Social prescribing at the earliest opportunity would be the very best form of prevention. Introducing social prescribing for children at pre-school and in school, in the form of physical activity and play, would be an excellent and important first step in reversing Scotland’s worrying health trends. As I have said before, schools need to be seen more as community hubs. Because of the closure of local facilities, the facilities in the school estate are becoming more important, so we need to make them accessible, which we are currently not doing.

Social prescribing also needs to include access to volunteering—I make no bones about it. A friend of mine, Dr Frank Dick, who was the director of coaching at British Athletics, wrote a paper on the recruitment of volunteers from among people who are approaching retirement—which, in itself, is another form of social prescribing. We have to make sure that those opportunities are available.

I will talk a bit about active travel. I hear that the active travel budget has been increased. However, trunk roads are supposed to have an element of active travel in their development and I have not seen any evidence of that so far. The transport minister agrees with me that there is a huge discrepancy in access to cycle routes to work and other places between the better-off parts of our country and those that have lower earners.

I have talked about the closing of facilities due to cuts in council budgets. According to the Convention of Scottish Local Authorities, the budget that has just been announced will cut £230 million from councils’ discretionary spend—and that is if councils opt to raise council tax by the maximum of 4.8 per cent.

Photo of Keith Brown Keith Brown Scottish National Party

Mr Whittle has twice mentioned the proposed council budgets. Is the member likely to support an amendment to the proposed budget that would increase funding for local government? If so, where would that money come from?

Photo of Brian Whittle Brian Whittle Conservative

I think that council budgets should be increased, because social prescribing is an investment, not a cost. The Scottish Government is getting an extra £1.1 billion in Barnett consequentials and it is cutting council budgets again. The Scottish Government is cutting the budget for the very levers that are required to deliver on the social prescribing programme.

Photo of Brian Whittle Brian Whittle Conservative

I will get a wee bit further and then take an intervention, if that is all right.

We have just heard the minister say that the Scottish Government has increased the sport budget, but that is not true, because in real terms it has cut the sport budget again. We have heard talk about a delivery mechanism, yet GP surgeries have closed all over the place, and they are the access point for social prescribing. Patient numbers are increasing but there are fewer GP surgeries.

The reality is that, when it comes to social prescribing, it is people with the greatest health issues in the lower quintiles who have the least access to the services that they require. Every speech that the Scottish Government makes about inequalities highlights to me and to this chamber how little it actually grasps the problem. We know where the inequalities lie, and we know where the access to services is at its poorest. Where is the strategy to target those inequalities?

Photo of Brian Whittle Brian Whittle Conservative

It appears that I am in my last minute.

We have a system that acts against delivering on a report that I am sure we will all agree on. We have a Scottish Government that puts in place barriers to the development of a cohesive strategy. The solutions are clear. To be effective, we must have a delivery mechanism. We need GPs and healthcare workers who are armed with the knowledge of how and where to deliver services, not the current staffing crisis that they face. We need an educational environment that allows pupils access to extracurricular activity and teaching staff who are given the breathing space to deliver all their expertise. We need a third sector that is properly funded, because it is a massive contributor to this agenda.

By slashing council budgets again, the Scottish Government has put the very services that will be needed to deliver on the report’s recommendations under threat. At 5 o’clock today, MSPs will troop into this chamber to vote after what I wager will be deemed to have been a consensual debate, they will vote the motion through unanimously and, tomorrow, absolutely nothing will change.

If the Scottish Government agrees that physical activity is an investment, I challenge it to tell the Parliament how it intends to make good on that investment. So far, it seems that there is neither the will to drive this agenda nor an understanding of what is required to make the health of the nation a priority. Talk is cheap—it is time to show us the money.

Photo of David Stewart David Stewart Labour

Social prescribing is an idea whose time has come. I echo Lewis Macdonald’s comment that the concept is a crucial tool for the future of our health services in Scotland and further afield.

So, what is social prescribing? At a simplistic level, it deals with much, much more than simply physical activity. I will give an example. This week, The Sunday Times reviewed a book on neuroscience, which quoted the statistic that the impact that loneliness can have on a person’s emotional health is the equivalent of the impact of smoking 15 cigarettes a day.

Social prescribing is well defined in the Royal College of Occupational Therapists briefing to MSPs as being

“linked to an increased drive towards personalising health and social care and the widely accepted understanding that people’s health is determined by a number of complex and interrelated social, economic and environmental factors.”

Of course, social prescribing is not a panacea and it will not work for everyone or everything. It is a complement for people with serious and complex mental and physical health needs who will still require medical interventions and specialist one-to-one help.

Macmillan Cancer Support gave an interesting description of social prescribing as being about

“working with people as experts in their own lives”.

SAMH said that social prescribing can reduce

“the prevalence of mental health problems... demands on health services... and social exclusion.”

The minister should note that that conclusion was shared by the British Journal of General Practice.

An example relating to mental health that we probably all know about is that exercise referral schemes are useful treatments for mild to moderate depression. However, there are no such schemes in NHS Highland, NHS Orkney or NHS Shetland, which makes this a case of a rural postcode lottery—I would say that, as a representative of the Highlands and Islands, and the minister may wish to comment on that situation.

Other members have touched on best practice, and I will give four quick examples from across Scotland. The first two are from SAMH. Its “Active living becomes achievable” project relates to behaviour change and has helped more than 300 people to achieve active lifestyles, and its GP link workers in North Lanarkshire and Aberdeen have helped more than 5,000 people. Thirdly, the “Changing room” initiative—which I am particularly interested in as a long-suffering fan of Inverness Caledonian Thistle—which was launched in 2018, uses the power of football to encourage men to talk about improving mental health. The initiative involves the Scottish Professional Football League and Hibs and Hearts. I am glad that George Adam is in the chamber, because that example was raised at the Health and Sport Committee this morning. It was suggested that a GP could prescribe membership of St Mirren; he replied that it would not help our health very much, but I hope for the sake of his mental health that the team will stay in the same division, because relegation would be terrible for him.

Finally, Cycling UK has a body of evidence that cycling as a form of physical exercise is extremely good for health. It runs lots of schemes throughout Scotland, which are very positive examples of best practice.

The evidence that was received by the committee, of which I am a member, made it clear that an increased use of social prescribing would have the potential to lessen the burden on overworked and under-pressure GP practices, as well as to reduce the pressure on health and social care services and cut waiting times, unplanned admissions to hospital and delayed discharges—all aspects of service that are currently failing to meet their targets.

As the convener said earlier, the committee received written evidence from 97 organisations including the Highland green health partnership, the active Highland strategic partnership and many organisations that work nationally. They provided insights into the barriers to social prescribing, which can be particularly acute in remote and rural areas in the Highlands and Islands, where short-term funding arrangements for third sector providers has a significant impact on the sustainability of many key referral destinations.

The report’s findings identify the challenges that face the third sector, which is integral to the capacity for social prescribing, and note that further work is required to ensure that voluntary and community organisations have the capacity and capability to fulfil socially prescribed activities. Other barriers to realising the full potential of social prescribing have been briefly touched on, including workforce considerations. My understanding was that the Government was looking to add 250 link workers; however, unless I picked up wrongly what the minister said, I thought that he gave a slightly higher figure. I assume that 250 is the correct number, and would be happy to take an intervention from the minister to confirm that point.

Photo of Joe FitzPatrick Joe FitzPatrick Scottish National Party

If I gave a different figure, I clarify that 250 more is the right figure. What I may have referred to was 800 mental health workers.

Photo of David Stewart David Stewart Labour

I am happy that my research is up to scratch on this occasion. Details are required on where post holders will be based and their remits, including any differences in rural and urban areas.

The committee also notes that link workers should be tasked with helping to break down any barriers that people face to taking part in physical activity and sport in their communities. The establishment of a working group to identify opportunities is also constructive and I am sure that members of the committee and others across the chamber will follow progress closely. Government and public perception has shifted in recent years towards placing physical and mental health on an equal footing, and the next step is for social prescriptions to be placed on a par with medical prescriptions.

The report sets out that the growing inequality between active and non-active populations by area of deprivation, with its consequential health and wellbeing impacts, needs to be addressed. We all know that adults in the most deprived areas are the least likely to meet targets in physical activity guidelines, and any forthcoming investment should be prioritised and spent in the most deprived communities.

I will give an example—the minister, in particular, might want to take note of this. Members will know that the sports facilities fund, about which I am very enthusiastic, provides capital funding through sportscotland to communities. The Labour group recently submitted a freedom of information request, which found that only 11 per cent of that funding goes to the most deprived areas.

Photo of Joe FitzPatrick Joe FitzPatrick Scottish National Party

I have seen the Labour press release on that, and it fails to mention some of the caveats that accompanied the FOI. When an organisation applies for funding, the postcode that is used is that of the organisation’s headquarters. For instance, in Glasgow, when Glasgow City Council has applied—

The Deputy Presiding Officer:

I did say, “Very quickly,” minister. You have 10 seconds left, Mr Stewart.

Photo of David Stewart David Stewart Labour

Thank you, Presiding Officer. The minister stole my time there.

I am happy to get back to the minister about the issue, but I stand by the 11 per cent figure.

This emerging area of healthcare is very welcome. It is about empowering patients to take control of their lives. It will release GP consultations, reduce reliance on prescription medication and reduce pressure on NHS services, but the Government needs to address the major health inequalities in Scotland and focus on issues such as the distribution of funding through the sports facilities fund.

Tory members will benefit from hearing this. As Sir Winston Churchill said,

“I never worry about action, but only inaction.”

The Deputy Presiding Officer:

We are very short of time for this debate. I am already looking at cutting speeches.

Photo of Alex Cole-Hamilton Alex Cole-Hamilton Liberal Democrat

Thomas Edison once said:

“The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.”

A hundred years on, we still have not achieved that vision. In many ways our diet is worse, our engagement with physical activity is poorer and our relationship with alcohol is more problematic. I do not doubt the sincerity of the Scottish Government’s commitment to any of those things, but that commitment has been shared by every First Minister, every cabinet secretary for health and each of their Opposition counterparts since the beginning of devolution, so I am glad that the committee embarked on its inquiry. I am grateful to the clerks, our witnesses and the members of the public who participated in our community-based sessions.

By necessity, improving the health of our nation should be about more than just the alleviation of symptoms. The reach of our ambition should be to instil a thirst for activity, both physical and mental, in all our constituents. We then need to meet that thirst with the ability to access services and opportunities.

In a basic sense, Edison’s futuristic vision of the doctor of the future—to set that in the context of modern-day healthcare—is one of prevention, and it can be delivered in part through social prescribing. It represents a way in which primary care professionals can connect people to a range of local, non-clinical services. Some prefer terms such as “lifestyle coaching” or “social connectedness”, but those interventions work, and the evidence of their impact is empirically verifiable.

Following a study in Bristol in 2017, The King’s Fund issued a report that shows that there is emerging evidence that social prescribing can lead to a range of positive health and wellbeing outcomes, including helping to alleviate depression and anxiety.

Sport and physical activity can change lives—we all know that. They not only improve physical wellbeing, but help our mental health. In 2018, ScotPHO—the Scottish Public Health Observatory—reported that only 65 per cent of adults and 37 per cent of children were meeting targets in Scotland’s physical activity guidelines, with adults in the most deprived areas least likely to meet them. There is a growing inequality between active and non-active populations by area of deprivation.

Kim Atkinson, who is the chief executive of the Scottish Sports Association and a regular witness at the Health and Sport Committee, told us that there are 13,000 sports clubs, with 900,000 people attending those clubs. It is not all bad news. Some of those people are self-prescribing social interventions, and as Dr William Bird said to our committee, we should do everything that we can to ensure that we do not impede that access.

I pay tribute to Edinburgh Leisure in my constituency. It seeks to bridge the health inequality divide by offering those who are out of work and on state benefits access to Edinburgh Leisure training facilities at a cost of £10 per calendar month. That really does reduce barriers to people getting active and staying well, both physically and mentally. However, any cost can present a barrier, even a motivational one.

My party would invest in sport, support people to make informed choices and extend the rights of GPs to social prescribing, including free access to exercise programmes if they judged that it would help a person’s health and wellbeing.

Social prescribing should not be limited to physical activity. There are many examples of activities far beyond exercise that enhance a person’s mental wellbeing. As we heard from the convener, cultural and other forms of recreational activity should be included within the remit of social prescribing as they have a proven place in improving overall health outcomes. That view was supported by colleagues in the Culture, Tourism, Europe and External Affairs Committee during their 2020-21 pre-budget scrutiny.

The Shed in Muirhouse, an area of high deprivation in my constituency, works with some of the most socially excluded constituents that I represent and provides a fully equipped workshop where people affected by social isolation or mental ill health can build or upcycle furniture under expert tuition. It is not about calorie burning, but it increases the orbit of the social universe of some of my most isolated constituents.

However, like many services that we have heard about today, it struggles to keep going financially and to build awareness of the service that it provides. We need to do more to ensure the sustainability of such offers and connect people with them.

That is why I support the recommendation of our committee that 5 per cent of the integration joint board budgets be diverted to social prescribing. To that end, the Scottish Government has been committed to a GP link worker to feed people into those organisations. However, I do not think that we are making the progress that we should. All told, there are only 30 link workers in Edinburgh and the Lothian region and Muirhouse does not yet have the capacity to adequately embrace that connection.

Awareness raising is also key. It forms a large part of the work of the European-funded mPower project in NHS Ayrshire and Arran, NHS Dumfries and Galloway and NHS Western Isles. It is anticipated that by the end of 2021, at least 1,200 people over the age of 65 who live in the Scottish mPower area will have been supported to complete their own personal wellbeing plan. That should not be limited to pilots or good practice in certain regions; it should be mainstreamed and rolled out across the country.

I realise that I am coming to the end of my time. I will finish by saying that I agree with Gerry Power from the Health and Social Care Alliance, who, last October, as part of a different inquiry, highlighted that at local level, third sector organisations must not simply be seen as the default position when there is a lack of resource but as part of the fabric of our primary care offer.

It is not called the national health service for nothing. If it were just about treating symptoms, it would be a national sickness service. It is not, and we need to think in those terms.

The Deputy Presiding Officer:

I move to the open debate. Every opening speech has gone over time. We are now short of time, so speeches must be strictly six minutes.

Photo of George Adam George Adam Scottish National Party

I am a strong believer in social prescribing. It was Brian Whittle and I who pushed for the committee to inquire into the issue, because I have seen what a big difference it can make in people’s lives. I know how passionate he is about the issue, so I can understand that he is frustrated, but—in all honesty—gaunae cheer up a wee bit and look at some of the positive things that we are doing? There is so much that we can look at. I have found in life, that instead of sitting and moaning about everything and snarling at people, you get a hell of a lot more done with a wee a smile on your face, when you are trying to change things.

On a positive note, I agree with social prescribing for two very distinct reasons: one is the radical difference that it can make in people’s lives and the other is that I believe that it is the way forward.

Most of us agree that physical activity, sport and exercise are vitally beneficial to the wellbeing of us all, and that they can be life changing, which is why social prescribing is so important and plays a significant role in preventative care for health and wellbeing.

There was much debate in the committee about the term “social prescribing”—whether it explains the concept properly and people understand what it is. The term itself has been around since the 1990s and means that instead of clinical intervention, a doctor can prescribe physical activity, volunteering or a community activity as treatment, rather than more traditional methods of health care.

Signposting from primary care to a range of community-based activities has been shown to encourage people to seek their own solutions—which is vital—to make connections within their community and to receive support for their overall wellbeing and not just one condition.

I heard at the committee meeting earlier today that a GP has prescribed a football season ticket. Football was mentioned earlier on, and it was said that although it might help a person with loneliness, it might create other issues.

As has been stated, the 2019 “UK Chief Medical Officers’ Physical Activity Guidelines” sends a very clear message, which is worth restating. The document says:

“If physical activity were a drug, we would refer to it as a miracle cure, due to the great many illnesses it can prevent and help treat.”

The same conclusion was reached by the Health and Sport Committee in our inquiry on the ability of social prescribing to make an impact on physical and mental wellbeing. We agreed that there is no doubt that social prescribing can contribute massively to the healthcare system and that

“Addressing accessibility to, and awareness of, community and voluntary schemes will improve individuals’ health and wellbeing outcomes, begin to shift the balance of care from acute to community settings and help achieve national outcomes.”

More important, social prescribing puts the patient at the centre and ensures long-term solutions for on-going issues.

Although social prescribing can directly improve waiting times, help to make improvements in unscheduled care and ease pressures on accident and emergency services in hospitals, the committee explored the challenges that exist in using those approaches and increasing awareness and access to local services. It is important that we, as members of the Scottish Parliament, help to raise awareness of organisations in our constituencies.

As many members know, I am not one to be asked twice to mention Paisley. When I mentioned Paisley earlier today, I received a tweet from someone who said that George Adam deserves a medal for creativity in weaving—see what he did there?—Paisley and St Mirren into a full spectrum of topics. I will continue with that today.

Social prescribing is being successfully utilised across Renfrewshire. One example that comes to mind is the community connectors project, which has helped more than 1,000 people across Renfrewshire by issuing cultural and social prescriptions. The programme aims to free up GPs’ time so that they can focus on acute medical conditions, and it is working for hundreds of my constituents across Paisley. All 29 GP surgeries in Renfrewshire have signed up to have a social prescriber, who works with patients for whom medical intervention is not necessarily the most appropriate route. Patients can be referred by their prescriber to nearby social and cultural organisations to get the targeted support that they need, and to help them to feel part of the community.

Although the work of GPs and our NHS is undoubtedly vital, for many people 10 minutes in the doctor’s surgery is not enough. When a person has had a physical or mental health issue, getting back out into the community after a period of isolation is often very difficult for them, and many people simply do not know where to turn for support. Programmes such as the community connectors programme can help people to access services—from counselling services to swimming clubs, to relaxation sessions, to walking groups—and can help with physical and mental health concerns.

I could not, of course, continue my speech without mentioning that the St Mirren FC community trust runs a get fit programme. The “football fans in training” programme runs for 13 weeks and ensures that people have the opportunity to change their life and move forward.

I am aware that the Scottish Government always focuses on people, so it is great to see continued emphasis being placed on supporting the whole person. For example, the Scottish Government’s “A More Active Scotland: Scotland’s Physical Activity Delivery Plan” demonstrates how overall health and wellbeing initiatives can make a difference across portfolios.

We all have to work together, and we need to trust one another. The Scottish Government, the NHS, GPs, local authorities and providers all need to trust each other in order to ensure that we can make Scots better by finding a better way to help them.

Photo of Elizabeth Smith Elizabeth Smith Conservative

I, too, thank the Health and Sport Committee for a very interesting report, but I concur with my colleague Brian Whittle, who said that we have been here before. I can count at least four debates in 13 years—but none in a health minister’s debate time—in which we have talked about exactly the same themes.

There are two very specific challenges. The first is translation of common sense into action that is valued and followed across the population. The second challenge is in inculcation of a different culture in respect of approaching our lives from a health and wellbeing perspective. Both are proving to be elusive—and have been for many years. Despite all the warm words and cross-party agreement on so many aspects of the debate, there has been very considerable difficulty in making the real changes that are required. We must be asking ourselves why we have, so far, been unable to turn agreement into real action.

I fully understand why investment is so important—not just in financial terms but for wellbeing. David Stewart mentioned prevention, which is critical. Increased financing of link workers, who are trained to assist with physical exercise or other opportunities in our communities, is welcome—not least because they can establish a positive link to ensure that the relationship between good health and wellbeing is embedded in their communities. That should build on the 900,000 people who attend the 13,000 sports groups in Scotland, and it should assist primary care providers in being the support that many young families require. That could be about advice about diet, help with walking children to school, or information about cycle lanes or about joining clubs and societies. We should not forget how important that is for many young people.

As members know, social prescribing has been supported in Scotland for the past 30 years. In 2016, the Government began investing in community link workers, starting with work in general practices—in particular, in socially deprived areas. That sends an important message. As Brain Whittle mentioned, it is increasingly difficult for GPs to ensure that they can carry out their work because of closures or downgrading of GP surgeries. There is also a rural aspect that is crucial.

Volunteering has come up many times in the education brief and in the cross-party group on sport. Several members who are here today have attended those meetings. Volunteering is critical to how our communities survive and thrive. We have an army of wonderful volunteers, but they are not always channelled in the right direction and do not always feel welcome, because bureaucracy gets in the way and they are not valued.

Trust, which George Adam mentioned, is essential but must be underpinned by communities being able to understand what is required from a holistic approach. If we do not have a holistic and cross-party approach, we will keep going around in circles. I know that politics is structured around portfolios that are based on certain topics, but there must be a joined-up approach that makes it easier for people to see what that holistic appeal is. We are not good at that, yet.

There are three things that have been quite powerful to me in my time in Parliament. I remember my first Education and Skills Committee meeting in May 2007. The topic was school meals and we listened to evidence from Hull in England. There had been huge success there in ensuring that youngsters were taking up school meals through the youngsters being involved in setting menus and learning what is important about using locally sourced products. We in Scotland are still not good at using the huge advantage that we have in respect of our local produce. The more that people are involved in decision making, and the more evidence we hear from places where it has worked properly, the better we will be.

It is also important that there be better co-ordination between public bodies, local authorities, arm’s-length external organisations and the general public, so that we can take advantage of the diverse skills that are on offer, because we are still not using them as we should. That is a challenge for Parliament, so we need to do something about it.

We cannot stand still any longer, and we cannot just go around in circles. We must have collective will, trust and the ability to ask and answer tough questions.

Photo of Sandra White Sandra White Scottish National Party

I thank everyone who came to the committee to give evidence and those who sent in written evidence. I also thank the hard-working clerks who compiled the report and the members of the committee, who took part in that work too.

As Liz Smith said, social prescribing has been around for many years; it is just that it has not always been called that. Years ago, we were told to go for a walk or take up a sport because it was good for us.

I agree with Liz Smith that a huge culture change is needed on the part of not only the general public but GPs. Working together is hugely important. That is something that came across clearly when we spoke to the individuals and organisations that came before the committee.

Things have changed. We now eat a lot of fast food and a lot of people have sedentary lifestyles. Years ago, children could play in the streets, and there were not necessarily lots of cars. There has been a culture change in that respect. We have to be aware of that.

On the points that Brian Whittle made, I cannot be as humorous and gentle as George Adam was. The report is a consensual one, but we can also talk about how we feel about the issues and what people have told us. However, we cannot use the report as a tool to batter everything that has come out of this Parliament. That is a sad fact of life. If Brian Whittle looked at the figures and saw the number of food banks that we have, the number of people who are on universal credit and the number of people who are not able to survive, he might understand why people in certain areas have health problems. Look to your own Government, not everyone else’s. You should be quite ashamed of yourself for the way that you said that.

Photo of Brian Whittle Brian Whittle Conservative

What we are talking about is not a cost—it is an investment. We are asking the Scottish Government to invest in social prescribing, specifically in deprived areas. Do not blame everybody else: you have the levers to do something about it.

Photo of Sandra White Sandra White Scottish National Party

I think that you said “investment” three times after you said that you were not talking about investment. Look to yourself and your Government in Westminster. People are dying due to universal credit and not getting money as a result of being sanctioned. Think on that. I am sorry that I had to say that, but I cannot let it go.

The Deputy Presiding Officer:

I remind all members that they are not having private conversations and that everything that is said should go through the chair.

Photo of Sandra White Sandra White Scottish National Party

Others have mentioned exactly what we mean by social prescribing, so I will focus my speech on one section of society whose issues I and many others have championed for a number of years: our older people. I also want to touch on the work of the committee with regard to the evidence that we received from across the country, which helped to inform our report.

With an increasing ageing population, we need to ensure that everyone can take part in physical activities, and we need to put forward the case that physical activities and sports are not just for the under 50s. There are many benefits to taking part in physical activity. As the convener and George Adam have already said, if physical activity were a drug, we would refer to it as a miracle cure due to the great many illnesses that it can prevent and help to treat. That should be stated at the top of any report on health, because it is a clear endorsement of social prescribing.

What are some of the activities that people can take part in? Age Scotland has advocated that older people take part in walking sports, which help to engage older people in regular activity, and the physical and mental health benefits of doing so are evident.

According to Age Scotland, more than 2,500 women and men across the country play walking football at least once a week. We know from studies that participation in walking football reduces blood pressure and cholesterol and helps to prevent heart disease and stroke, as well as improving general fitness and wellbeing.

Keeping physically active also enables older people to stay mentally active and reduces the social isolation and loneliness that have so much to do with mental ill health. That needs to be taken into account when we consider social prescribing.

Like many members, I have many organisations in my constituency that do a great deal of work. I have mentioned Annexe Communities on numerous occasions. It is based in Partick, in the community, and it has a jam-packed activity calendar that includes yoga, walking, tai chi, salsa, line dancing and ballroom dancing. Having such activities in the community is what social prescribing is all about.

I am going to have to cut out half my speech.

I am pleased that the minister mentioned community link workers, because I was going to ask him to say, in his closing speech, whether we can have more link workers. He has answered my question, so he need not do so again. Link workers are crucial to social prescribing.

The report sets out lots of things that we learned about how social prescribing can prevent

“long term conditions and dependence on pharmaceutical prescriptions.”

I agree with Liz Smith that we must ensure that there is joined-up thinking on the matter. I will stop there, Presiding Officer, because I have run out of time.

Photo of David Torrance David Torrance Scottish National Party

As we have heard, the benefits of physical activity to our health and wellbeing are well documented and widely acknowledged.

The term “social prescribing” has been around since the 1990s, and there is no doubt that some noteworthy initiatives and programmes are being undertaken across Scotland, but there is evidence that far more needs to be done to promote the approach.

During the gathering of evidence for the committee’s report, it was encouraging to see many written submissions from a wide range of organisations and boards. If we are to achieve the shared vision of a Scotland in which people are more active, more often, we must acknowledge that everyone’s voice is important and must be heard.

If we are to ensure an integrated approach that is consistent and relevant to our local communities, we must do all that we can to tackle barriers to accessing the right support and delivering programmes. To that end, I was pleased to learn about NHS Health Scotland’s work with academic partners and physical activity providers to co-produce quality standards for physical activity referral, to achieve greater quality and consistency in the design and delivery of referral schemes in Scotland.

As a Fife MSP, I was particularly interested to read the submission to the committee from NHS Fife and Fife Council, on behalf of Fife health and social care partnership. The partners said:

“prescribing physical activity and sport does not lead to a sustained participation in physical activity and sport. In particular, prescribing to ‘sport’ is not sustained.”

That is an important point, which we must address. How can we ensure that exercise referral programmes are effective in promoting long-term behavioural change and increased participation in physical activity? The Fife partners went on to say that

“There has been some success with informal referrals made to some participation programmes for young people and adults”, but pointed out that

“Many clubs are not in a position to receive referrals and to support individuals.”

That is why I very much welcome the value that the Scottish Government places on the significant contributions of the voluntary sector and community organisations to improving the health and wellbeing of people across Scotland.

I also welcome the support that the Scottish Government provides in that regard, which includes support for the Paths for All programme. The programme is funded by the active Scotland division, with the aim of developing and delivering an action plan for Scotland’s national walking strategy. Paths for All’s Scottish health walk network brings together more than 160 projects, all of which are aimed at supporting people to walk more.

There is also the amazing changing lives fund, which was launched in 2018. The initiative, which is a partnership between the Scottish Government, sportscotland, the Robertson Trust and Spirit of 2012, provides additional resource to the sporting sector and community sectors to better address individual and community needs through sport and physical activity and to support participants to become and stay active.

Although there is currently no formal social prescribing programme for physical activity or sport in Fife, there are a number of programmes that encourage and promote an active lifestyle, which I will take the opportunity to highlight.

Bums off seats, a Fife walking initiative, provides free, local health walking opportunities that are led by a trained team of volunteer walk leaders. A health walk is a free, short, local walk that is suitable for most people—even those with long-term health conditions. Now in its 15th year, the Fife Council-funded project, with support from Active Fife and Paths for All, appears to have found the secret to sustained participation, as it encourages the less active members of the community to discover the benefits of an active lifestyle, such as improved physical and mental health and increased wellbeing.

Fife Sport and Leisure Trust has a referral programme for specific health conditions, such as coronary heart disease and stroke. Active options 2 is a programme of referral-based health classes for people who are living with long-term health conditions. It delivers exercise that is tailored to a person’s functional ability, regardless of what long-term condition they have. Delivered by the trust and led by specialist instructors, the health classes are delivered at four levels, ranging from level 1, which is chair based for those who have limited standing balance, through to level 4, for those who are independently mobile and already active.

During the evidence-gathering sessions, I was also interested to hear the evidence of GPs who had concerns about the concept of social prescribing. Their reasons were varied and ranged from worries about time constraints to perceptions that it was not part of their role and the lack of strong evidence demonstrating the long-term effectiveness of social prescribing.

That raises interesting questions about whether referral pathways and access to social prescribing should be solely the responsibility of health and social care professionals. Fife partnership noted that, although medical professionals are traditionally the most appropriate route for referrals, community link workers, social care providers and the third sector are increasingly involved with individuals and are already appropriate resources to make referrals to a range of interventions. Therefore, making referrals should no longer be down to health professionals alone.

Figures from NHS Research Scotland show that 90 per cent of all health contact takes place in primary care, with most of it taking place through visits to GP surgeries, dental practices and pharmacies once someone is already unwell. If we are to effect real change and increase the role of social prescribing in improving health and wellbeing, focus must be given to implementing long-term systems and approaches that will facilitate improved access to non-clinical programmes, services, events and sources of support before there is a need for health service intervention.

I welcome the report and its recommendations, as well as the Scottish Government’s response and its commitment to improving the health and wellbeing of people and communities across Scotland.

I very much look forward to the establishment and progress of the Scottish Government’s social prescribing working group and to the progress of NHS Health Scotland as it continues to support NHS boards and integration authorities to implement physical activity social prescribing by embedding the national physical activity pathway in existing practice.

By working together, we can continue to make great strides in positively influencing individual practices and personal behavioural choices, and, in turn, build healthier communities by preventing long-term conditions, rather than managing them.

Photo of Mary Fee Mary Fee Labour

I welcome the opportunity to speak in this debate on something that might not be at the top of the political agenda but that, when utilised effectively, can change lives and deliver long-term health and wellbeing benefits. There might be different views across the chamber about how to utilise and maximise social prescribing, but we should all agree that it has the potential to change lives for the better.

The Scottish Government’s commitment to establishing a working group to “identify and communicate” best practice for social prescribing is strongly welcomed. I hope that any outcomes from the working group will make the utilisation of social prescriptions by professionals more efficient and effective.

We need to ensure that there is no postcode lottery across the country. To do that, we must ensure that best practice becomes a national standard. Understanding how social prescribing will work in practice is fundamental to promoting the concept to health and social care professionals, and it will ensure promotion of its benefits when it is rolled out.

Preventative spending is key to protecting the long-term stability of the national health service as it faces ever-increasing pressures and demands. Social prescribing is one key tool in the preventative measures mix that is fundamental to improving health and wellbeing. Social prescribing must not only offer physical activity but look at wider cultural and leisure activities that are suitable for the individual.

Last week, I had the opportunity to spend time with instructors from Disability Snowsport at Snow Factor, at Braehead, which is the only indoor ski slope in Scotland. They were keen to point out that, regardless of any disability or injury, or their level of experience, anybody can ski, and, in their view, the benefits to people’s mental health are immeasurable. I had the opportunity to take part in a session, which I confirm was great fun—I highly recommend it to all.

I believe that two major concerns must be addressed in the debate. The first concerns referral pathways for social prescribing and health and social care workers’ awareness of its benefits. Although the majority of prescriptions come from GPs, it is evident that not all of them fully support social prescribing. I note, from the Scottish Government’s response to the committee’s report, that

NHS Health Scotland is supporting NHS Boards and Integration Authorities to implement physical activity social prescribing by embedding the National Physical Activity Pathway”.

Perhaps the minister, in his closing remarks, could provide me with an update on how it might be possible to effect such implementation in a way that would ensure a national standard for social prescribing rather than a postcode lottery.

If some GPs are unsupportive of social prescribing, training should be made available to overcome that attitude. All GPs are very aware of the benefits of physical activity in supporting long-term health and wellbeing. In the chamber, we often talk about behaviour change, and social prescribing has a key role to play in changing long-term behaviour.

I welcome and support the role of community link workers. Greater use must be made of social prescribing through them, particularly to address situations in which GPs are resistant to the idea or do not have the capacity to assess individuals fully to ensure that prescribed activities are achievable, will be a good match, are sustainable and can offer the support that is required to enable those individuals to take part. If we are to see a real difference in health and wellbeing in the most deprived areas, the number of community link workers will need to be increased beyond the number that is proposed by the Scottish Government, which has a target of 250 such workers being in place by 2021.

The second of my concerns is about resourcing and capacity. Although Labour supports the idea that social prescriptions should be treated equally with medicinal prescriptions, a large obstacle to achieving that would be the cost. The majority of social prescriptions would require co-operation with the third sector, which, like local authorities, has faced difficult financial circumstances over the past decade. It is not always guaranteed funding, especially from the public sector. To increase the capacity for third sector organisations to be involved in social prescriptions, their voices must be heard. Therefore, I hope that the proposed working group will include a range of voices from that sector.

In closing, I reiterate my support for social prescriptions. It is clear that they have support both in the chamber and in the Government and that they have the potential to change lives as well as save resources for the NHS. However, in order to drive such change, there must be in place a strategy that does not financially restrict third sector organisations and local authorities.

Photo of Joan McAlpine Joan McAlpine Scottish National Party

I am delighted to speak in the debate, and I congratulate the Health and Sport Committee on the publication of its report. Although it focuses on the effect of sport, I am keen to underline the importance of culture to social prescribing and was pleased to hear Lewis Macdonald acknowledge it in his opening remarks.

There is now a national outcome on culture. In its pre-budget scrutiny, the Culture, Tourism, Europe and External Affairs Committee, of which I am the convener, has highlighted the importance of funding participation in culture across Government portfolios. In social prescribing, culture is particularly beneficial for the prevention of long-term issues, especially those affecting mental health, although, of course, some art forms, such as dance, also benefit physical health.

We are especially keen to see access to culture extended to more marginal groups such as those on low incomes. A brilliant example of that is Sistema Scotland’s project in Raploch, Stirling, which I visited this month in my capacity as the committee’s convener. As members will know, Sistema runs orchestras and music classes for children in Stirling, Aberdeen, Dundee and Glasgow, but it does much more than that. Based on a Venezuelan model, Sistema Scotland aims to use music making to foster wellbeing, confidence, self-esteem, pride and aspiration among the children and young people who take part. It is very successful in that aim, as I discovered when I observed the wonderful tutors, who are all working musicians, taking various classes with laughing, happy and very hard-working young musicians.

Sistema’s effect on wellbeing has been properly documented by the Glasgow Centre for Population Health, which conducted independent analysis and found that there are seven main areas of a child’s or young person’s life that can be positively affected by participation. In relation to education, participation improves concentration, listening, co-ordination and school outcomes, all of which benefit health. In relation to life skills, participation improves problem solving, decision making, self-discipline and leadership. There are emotional benefits—

Photo of Christine Grahame Christine Grahame Scottish National Party

Ms McAlpine, can you bear with me for a minute? Could you slip in a wee bit about physical activity—even if it is just about blowing a trumpet or singing? The debate is about physical activity, and I would like to hear you link in a little bit about that.

Photo of Joan McAlpine Joan McAlpine Scottish National Party

Thank you, Presiding Officer. With respect, I think that improving wellbeing and mental health through culture improves physical outcomes, too. Improved educational and life outcomes have preventative health benefits, so the benefits that I have listed, including cultural benefits, from participation in Sistema’s classes are very relevant to today’s debate.

The Glasgow Centre for Population Health also outlined the physical benefits of accessing Sistema’s classes, such as the availability of healthy snacks, opportunities for games and exercise, and the creation of healthy habits for adulthood.

I am a co-convener of the cross-party group on culture, and one of our recent meetings focused on social prescribing and cultural activity, which, as I said, includes physical activity through art forms such as dance and drama. Culture Counts, which is the CPG’s secretariat, has conducted a considerable amount of work in that area and, indeed, made a very helpful submission to the Health and Sport Committee’s inquiry into social prescribing.

The submission contained proven evidence of cultural prescribing and showed that cultural engagement is protective against the development of chronic pain; that symptoms of moderate to severe postnatal depression were significantly improved in mothers who attended group singing workshops; that people who take part in the arts are 38 per cent more likely to report good health; that arts therapies reduce the physical and emotional suffering of people with cancer, as well as the side effects of their treatment; and that listening to music before, during or after surgery reduces post-operative pain, anxiety and use of analgesia. Culture Counts also found that outcomes were better if the cultural activity—I am sure that this applies to sport, too—was linked to structured programmes with practitioners who could offer support and a high-quality experience.

There are many examples of cultural social prescribing around Scotland. I have mentioned Sistema, which uses classical music, but I have also visited Morsecode Management, which is a rock music management company that has worked in Glasgow hospitals to improve wellbeing among staff as well as patients. I would also like to mention Luminate Scotland, which is a creative ageing organisation that is funded by the Government and the Baring Foundation. It is now eight years old and has moved from holding a successful festival to providing a year-round programme, with a vision that all older people will take part in quality arts and creative activities. Of course, that is particularly beneficial for those who might be suffering from memory problems, and there are many art forms that tackle such difficulties.

I think that we all agree that social prescribing is a good thing, but I agree with colleagues that demands for more funding in one area will require cuts elsewhere. However, given that there is a national outcome on culture and that wellbeing is now considered equal to gross domestic product in determining our success as a country, it is imperative that every area of Government is encouraged to do its bit in that regard.

In my committee’s recent arts funding report, we recommend that the Scottish Government articulate its spending plan for the forthcoming culture strategy, including what funding will be earmarked for the arts from other portfolios to deliver the national outcome on culture in a cross-cutting way. The committee also recommends that the Government give serious consideration to the culture strategy being supported, on a cross-portfolio basis, by a baseline target for national arts funding above 1 per cent of the Government’s overall budget. That is not about producing money from nowhere, but about portfolios beyond culture—including health—recognising its importance in delivering their outcomes. That, Presiding Officer, is another debate for another day.

The Deputy Presiding Officer:

Thank you. On that point, I am devoid of the Health and Sport Committee’s report and I bear correcting if culture is mentioned in it—I see wee nods. That is a lesson for me to make sure that I have a report in front of me, Ms McAlpine. I have duly been rebuked and have learned a lesson. I will do that next time.

Yes, I know—I am not perfect. I am nearly perfect.

Photo of Annie Wells Annie Wells Conservative

Is it still six minutes that I have, Presiding Officer?

Photo of Annie Wells Annie Wells Conservative

Perfect. Like Liz Smith, I, too, thank the Health and Sport Committee for its work, which has made a valuable contribution as we seek to understand how social prescribing can improve health and wellbeing.

I think that everyone in the chamber can agree with the committee that social prescribing has the potential to improve individuals’ health and wellbeing outcomes, and there is cross-party agreement that social prescribing is one way to begin to shift the balance of care from acute to community settings, easing the strain on key services.

The Scottish Conservatives have frequently made the point in various policy areas that investment in early intervention will save money over the long term. Our 2016 manifesto called for additional support to be directed to social prescribing. Building on that manifesto, our 2016 mental health paper called for a renewed focus on social prescribing and, in December 2018, we launched our loneliness strategy, which called for greater social prescribing and a faster roll-out of the community link worker programme.

No one is pretending that increasing social prescribing and raising its profile will be easy or simple, but it is clear that we must do better. In Scotland, only two thirds of adults meet guidelines for physical activity; we have one of the worst obesity records among Organisation for Economic Co-operation and Development countries; and there is a clear gap in participation between people from richer and poorer areas. When it comes to participation in physical activity and sport, the 2018 Scottish household survey found a 21 point gap between the participation rates in the most deprived and the least deprived areas of Scotland. As the committee has identified, there needs to be more public awareness of social prescribing and the value that it can bring to people’s lives.

The general consensus from submissions to the committee is that people who are used only to receiving prescriptions under the medical mode, will not be used to, or, in some cases, prepared for a social prescription. The public are more at ease with the traditional medical prescription than with social prescriptions.

We all recognise that improvement will not happen overnight, so there is a clear reason to keep talking about the issue in the chamber, but we need the pace of progress to quicken. In that vein, I hope that this debate can be another point to kick-start breakthroughs that will lead to an increase in the uptake of social prescribing.

Today, I will focus especially on how social prescribing can have positive impacts for elderly people and for everyone who is looking to improve their mental health. As far as older people are concerned, I know that my late dad would have benefited from social prescribing. He was eventually diagnosed with chronic obstructive pulmonary disease. There is no doubt that early intervention social prescribing—perhaps 20-odd years ago—would have benefited him hugely. Of course, he would have had to engage with the social prescribing, which is one of the issues that we face in increasing its uptake. As I have already mentioned, many people just do not treat such a prescription in the same way that they would a medical prescription.

The Royal College of Occupational Therapists has found that

“at a universal level, there should be information available to everyone within a health and care environment about how to participate in healthy activities.”

At a more targeted level, many people will need a little extra support to get involved in physical activity for the first time. Age Scotland highlighted in its briefing for the debate that sporting opportunities must be inclusive for all age groups, something that I also heard in my discussions with Contact the Elderly, now known as Re-engage. When I attended a tea party hosted by Re-engage, the benefits of opportunities that include all ages quickly became apparent, especially those that involve interaction between different generations. It is worth focusing on making sporting opportunities work for older people—that is one area where my dad might have been more persuaded to engage with a social prescription.

It is clear across the country that the supply of mental health services does not meet the demand, that too many people wait too long for them and that more effective management and resources need to be put towards them. Social prescribing is one key way in which we can limit some of the strain on those services.

SAMH highlighted the importance of early intervention in reducing the prevalence of mental health problems, social exclusion and demand on health services. Its research found that 87 per cent of GP respondents to their survey said that there was a need for information on local services, including social prescribing opportunities. We cannot easily create cultural change, but we could help GPs to have the information that they need on social prescribing opportunities. I hope that we can finally start to see a real shift towards early intervention and real progress towards making social prescribing a far more common practice.

Photo of Richard Lyle Richard Lyle Scottish National Party

I welcome the opportunity to contribute to this important debate on social prescribing. I noted with interest the recommendations and findings of the Health and Sport Committee’s report. I am a bit puzzled: when we do a report, should we not also look at where we get the money to do the things that people have come out with this afternoon? Perhaps we should bring in that budget scrutiny in the next couple of years.

Photo of Richard Lyle Richard Lyle Scottish National Party

No, I will not. Physical activity, sport and social prescribing play a significant role in preventative care for health and wellbeing. The term “social prescribing” may be unfamiliar to many, but it has been around since the 1990s, at least. As we know, it is the alternative to a clinical intervention: a doctor can prescribe physical activity, volunteering, or a community activity, for example.

Crucially, social prescribing also refers to the signposting from primary care to a range of community-based activities, encouraging someone to seek their own solutions. Community link workers or navigators are recruited to primary care and community settings to support people into activities that will address low mood, obesity, loneliness, poor fitness and so on. Staff can also address welfare and circumstances.

Social prescribing is backed up with a plethora of existing evidence to support the use of physical activity in maintaining and promoting healthy lives. In 2019, the UK chief medical officer’s physical activity guidelines state a very clear message:

“If physical activity were a drug, we would refer to it as a miracle cure, due to the great many illnesses it can prevent and help treat."

With regards to the evidence, in order to complement its primary care inquiry, the Health and Sport Committee agreed to undertake an inquiry to further consider social prescribing’s ability to tackle physical and mental wellbeing issues across Scotland.

The report explores the challenges that exist in using social prescribing to increase sustained participation in physical activity to improve health and wellbeing. It also examines the potential of wider issues around access to physical activity and sport, as well as how strengthening local assets and communities can complement social prescriptions.

Being physically active is one of the best things that we can do for our physical and mental health. I should take it up and my wife often tells me so, but I can testify to those effects from years of campaigning and leafletting across the country. That helps to make us more active; elections are very entertaining when it comes to physical activity.

Physical activity helps to protect us from many of the most serious long-term health conditions. That view is shared by the Scottish Government and the committee’s view is that the evidence of the benefits of physical activity is abundantly clear.

The World Health Organization has welcomed the Scottish Government’s “A More Active Scotland: Scotland’s Physical Activity Delivery Plan” for its systems-based approach to working across sectors and has recognised Scotland as one of the forerunner countries in responding to the challenges set out in its global action plan on physical activity. Social prescribing and wider preventative initiatives to increase physical activities in communities can directly improve waiting times, help make improvements in unscheduled care and ease pressures on accident and emergency in hospitals. Social prescribing and primary prevention approaches can also help to prevent long-term conditions and dependence on pharmaceutical prescriptions, and they have the potential to ease the pressure on existing health and social care services, as well as reduce waiting times, unplanned admissions to hospital and delayed discharge.

The Scottish Government’s 2018 “Waiting Times Improvement Plan” states:

“The health and social care system needs to maintain its focus on improving public health and the development of preventative models of care (including self-management). If we want it to be financially sustainable, tackle persistent health inequalities, improve long-term outcomes and reduce pressure on the workforce, we cannot simply react to the management of patients with long-term conditions without taking long-term action across the health and care system as a whole.”

That is why the Scottish Government is working with partners to realise the benefits that social prescribing can bring. In its response to the committee’s report, the Scottish Government set out how it is building capacity in primary care and other settings to provide integrated support, which includes a social prescribing element. Through community link workers and mental health workers, delivery programmes and support for community-led initiatives aiming to increase physical activity, improve overall physical and mental health, and tackle health inequalities are being progressed. Crucial to all that is the voluntary and community sector. I know that the Scottish Government greatly values the significant contributions of the voluntary sector.

Increased resources are also being allocated to building capacity and expertise in the healthcare system that will provide person-centred support. I commend the committee’s report to the chamber.

Photo of Bob Doris Bob Doris Scottish National Party

I thank the committee for what I consider to be a timely, focused and constructive report for the Parliament to consider this afternoon.

I will talk about the role of community anchor organisations in social prescribing. In particular, for the purpose of this debate, I will talk about Lambhill Stables in my constituency, although there are many other such organisations. Lambhill Stables is bounded by the Forth and Clyde canal and Possil Marsh; and also by Milton and Cadder—two areas that are not short of deprivation—and to the south sits Possil. The stables are also a short hop from East Dunbartonshire and Bishopbriggs, so the organisation has a very strategic location indeed for a community anchor organisation.

Lambhill Stables has a range of facilities in which we could see social prescribing fitting in seamlessly, whether through the community cafe and kitchen, with cooking classes; the bike hub, which trains individuals to repair bikes and provide a service to the community; the gardening group, which maintains the substantial lands at the stables; the art class; the history and heritage group; the knitting group; the computer classes; the youth group; the women’s group; the photography group; or the live music groups that meet twice a month on Friday evenings. We can see that it is a thriving community anchor organisation that is doing all that it can to serve the variety of communities around the location where it is based.

Lambhill Stables is also lucky enough to have me as the local MSP who holds surgeries there. I held a surgery there this morning before I came through to Parliament. Amelia, the general manager, asked me, “Are you speaking in this afternoon’s debate in relation to social prescribing?” I said “Not yet”, and she said “You probably are now.” She also said “Check for an email from Allan, the chairperson.” So, I did and found that he had emailed me a few days ago in relation to this debate. He had seen an article on healthandcare.scot, in which the Cabinet Secretary for Health and Sport, Jeane Freeman, pledged an expansion of social prescribing. He drew my attention to the working group that is to be established to look at best practice for social prescribing, and how we can build and expand on that best practice. He quoted the cabinet secretary as saying that there is

“more we can do to build on the growing momentum” in relation to social prescribing.

Allan said that Lambhill Stables is already actively engaging with the local NHS, primarily with GPs and with the health and social care partnership, in a positive and constructive way; however he also said, not as a criticism but as an observation, that it was rather slow.

Lambhill Stables wants to be part of the working group. It wants to be part of any national body or forum that can disseminate and share that best practice. That might also look at pilot projects on expanding anchor organisations to do more in relation to social prescribing—again, Lambhill Stables is the best place to do that kind of thing. I therefore ask Mr FitzPatrick to look actively at how Lambhill Stables could be part of that.

The Cabinet Secretary for Communities and Local Government, Aileen Campbell, will shortly visit Lambhill Stables to look at a variety of beneficial work that it does for the community. Interdepartmental working in Government to maximise a community asset, particularly in relation to social prescribing, is absolutely important. The report reflects, and the Government agrees, that there should be place-based support.

We are talking about regenerating our communities. There is no magic around social prescribing; we are talking about using the social capital of all our communities to interact with each other and build and foster those good, positive, social, emotional and active relationships. That is what Lambhill Stables does, and that is what social prescribing is about.

I was also interested to see what the committee’s report said about commissioning local services in relation to health and physical activity, and the ask for 5 per cent of health and social care partnership spend to be used for social prescribing and similar activity over the next couple of years. In relation to commissioning local services, including in relation to culture, which Joan McAlpine talked about, I would want to make sure that they are locally commissioned services, and that it is a bottom-up approach. The last thing I want is large well-intentioned organisations sweeping into my constituency and saying what is best for the people. The approach has to be granular, grass-roots and developed in the same way as in Lambhill Stables, or in Young People’s Futures in Possilpark, or Royston Youth Action—I could go on.

I mentioned youth providers. It is no longer youth work that they do, but youth, community and family work. Youth work is a key to and gateway into that. No longer is it about kicking a ball around with a kid; those workers are working with and supporting the wider family. Some cross-subsidy of those supports can lead to great results and outcomes coming to fruition.

I will finish by saying that Lambhill Stables would point out that there comes a point at which it can do no more, unless a funding stream is identified and planned, and the referral pathway is funded as fully as possible, with volunteers but also with hard cash. That is not an appeal for money—although of course it would like more money, because which organisation would not? Lambhill Stables is saying that it is keen to work constructively with Government, to do more, to get value for money, and to get the outcomes for the communities that we all represent, which have tragically poor health outcomes—they certainly do in my communities. We must do better, and social prescribing is a way of doing that.

I commend the Health and Sport Committee for bringing the debate to the chamber, and will leave my comments there.

Photo of David Stewart David Stewart Labour

The debate has been excellent, with thoughtful and well-researched contributions from across the political divide. In my opening speech, I said that social prescribing was an idea whose time had come, and many members echoed that thought in their contributions. They made up their own minds, with their own logic, but I was delighted with the unanimous view about the essential nature of social prescribing.

Lewis Macdonald, the convener of the committee, kicked off the debate. He made the point, which was echoed by other speakers, that if physical activity was a drug, it would be a miracle cure. He also talked about the role of physical activity in reversing type 2 diabetes. At least three members in the chamber are very active in the cross-party group on diabetes. It is a very important point.

Health is the real wealth in society. Brian Whittle talked about coming into Parliament four years ago and saying that he had arrived with much hope and much naivety. I do not know whether he meant that he now has no hope and no naivety, but certainly his contribution was well made—[Interruption.] I will resist responding to the point that was made from a sedentary position.

Mr Whittle also made the point that conditions such as type 2 diabetes are preventable and that 10 per cent of our health budget is spent on preventable conditions. He talked about the importance of social prescribing for mental and physical health. Alex Cole-Hamilton made a very polished speech in which he said that the doctors of the future will concentrate on prevention. He also echoed the point that social prescribing is about mental wellbeing and gave the example of The Shed in his consistency, which is in a socially deprived area.

George Adam reminded us that there is nothing new about social prescribing—the concept started in the 1990s—but it is an idea that can make a massive difference to our healthcare system. I liked his line that social prescribing puts patients at centre stage and empowers them, which is an extremely useful point.

Liz Smith talked about the difficulties in making the real changes that are required, and stressed that prevention is absolutely key. She made a very useful point about volunteering. Certainly, as an ex-member of the Scottish Council for Voluntary Organisations, I agree that volunteering is absolutely crucial. In many of our rural communities in particular, volunteers help communities to thrive. Of course, we need to take a holistic view.

Sandra White made very good points in championing the rights of older people. She mentioned walking football—that was not in connection with St Mirren at all, in terms of the day-to-day reality. We also should not forget that isolation and loneliness is a terrible curse on society and unfortunately, many elderly people suffer from that problem.

Mary Fee talked about social prescribing having the potential to change lives. She stressed that we need to avoid a postcode lottery. The longer I have been on the Health and Sport Committee, the more I see connections between inequality in general and healthcare, and the postcode lottery is one part of that. She echoed the point about preventative spend.

Mary Fee gave the good example of disability snow sports. She has not sent photos of that in yet, but I look forward to seeing them. She said that social prescribing is a very good “antidote” to mental health issues, but she shared real concerns about social prescribing referral pathways—which I am sure that the minister is aware of—and asked whether we need to look at having national standards.

Social prescribing is an emerging and innovative initiative in healthcare. It allows patient empowerment, releases GP consultations, reduces reliance on prescriptions for medication and reduces the pressure on NHS services. However, the Scottish Government needs to address the issues around the postcode lottery and health inequality.

I believe that social prescribing is one of the big ideas of the decade. However, it needs to be enacted. What we need is the will to do, and the soul to dare.

Photo of Miles Briggs Miles Briggs Conservative

As other members have done, I thank our Health and Sport Committee team for all that they do to support our work and for helping to draft the report that we are debating today. We have heard from a number of members across the chamber about the potential benefits of social prescribing, and I think that everyone agrees that physical activity has huge benefits for any person’s health and wellbeing, both physical and mental.

The report, which was also discussed at this morning’s Health and Sport Committee, makes interesting recommendations and it is important that we take them forward. During our committee’s medicines inquiry, we have discussed a lot of what has been debated today. The question has been asked about whether most people understand the term “social prescribing” and what it means in the real world. For many of our fellow Scots, it refers to their local walking group, the Wednesday club, or coffee with a neighbour or voluntary worker. It is important that social prescribing is considered not as a concept but as what we can do to improve the lives of our fellow Scots.

Over the past decade, social prescribing in this country has developed organically, which is a welcome step forward. From lifestyle coaching in Lanarkshire to green prescribing in Shetland, different communities will make sure that what suits their families and people will happen. The measurable and stated outcomes that can be achieved from health improvements, social prescribing and connecting people socially—and the mental wellbeing that those things provide, often very quickly—are important.

A number of members have mentioned the UK chief medical officer’s statement that,

“If physical activity were a drug, we would refer to it as a miracle cure, due to the great many illnesses it can help prevent and help treat.”

Perhaps the real conclusion from the committee’s report is that the theory of social prescribing is great but realising the potential of social prescribing will be the difficult part. Currently, the key way to connect people to a range of non-clinical services in their community is through their local GP. Joan McAlpine highlighted the many opportunities that there would be if we had a broader way to access social prescribing; however, if it is to be truly effective, primary healthcare professionals must buy into the concept—that is what the report highlights.

As Lewis Macdonald said, during its inquiry, the Health and Sport Committee heard an example from Argyll and Bute health and social care partnership that demonstrated that not all GPs value the benefits of social prescribing. Therefore, the need to build confidence around non-clinical alternatives is an important issue in the debate.

If social prescribing is to become integrated into primary care services, the Scottish Government will have to work with NHS boards and integration authorities to engage with general practices to map the non-clinical services that are available in their communities and to outline how they must become part of the mix to improve people’s health and care.

To me, the word “accessibility” is really important for the recommendations that we have made. In the area that I represent, City of Edinburgh Council last year aimed to cut 8.6 per cent from the sport and leisure budget, and, last summer, the council proposed that sport clubs should pay £35 an hour to use school sports halls. That proposal was put on hold, and I have been in communication with the minister about it. We need to look at how we can build capacity and what budget barriers are being put in place that could prevent that capacity from being realised. Brian Whittle outlined what the issue is about, and today’s debate must consider how we can develop sustainable capacity across Scotland. Council cuts often mean that front-line services and the third sector organisations that provide them are the first to face cuts.

If social prescribing is to be successful in Scotland, we will need to support people to access facilities and take down the barriers that clubs, galleries, sports clubs and local volunteering groups face. Liz Smith made important points about the value of our volunteers. Scotland’s integration joint boards are today discussing year-on-year cuts, so we need to ask ourselves how we can take forward a sustainable service around social prescribing.

I note the concerns about the Scottish Government’s proposed budget that COSLA outlined today. The Health and Sport Committee has said that it wants 5 per cent of each integration authority budget to be targeted to social prescribing, but I ask how that will come about, given COSLA’s warning about the proposed budget.

Bob Doris made a really good speech, and the positivity of organisations is important. However, ministers must realise that it is key that we build sustainable services and make sure that the positive work that is going on in communities across Scotland is supported for the long term and not just for today.

There are many serious health challenges in Scotland, but social prescribing can ensure a more active, healthier population and reduce demands on our GPs and NHS services. It can mean shorter waiting times for appointments and treatments, and fewer unplanned admissions to hospitals. Social prescribing can help people in Scotland to live healthier, happier, longer and more active lives, but it is part of the solution that we can take forward only if we properly invest in it.

Photo of Joe FitzPatrick Joe FitzPatrick Scottish National Party

I am grateful to everyone who has contributed to the debate for their views and suggestions on how we can realise the potential benefits of social prescribing approaches to improve the health and wellbeing of people in Scotland. I welcome the broad agreement that there are opportunities to strengthen the connections between healthcare practitioners and those who provide opportunities for people to improve their health and wellbeing in their local community.

Miles Briggs made an interesting point about what people understand by the term “social prescribing”. We will all have slightly different understandings of it, but its definition can be much wider than traditional physical activities and things such as walking clubs. Such aspects are important and we can understand them, because we see them in our communities, but it is important to recognise that the definition can be much wider.

That is why it was helpful that Joan McAlpine spent a deal of time in widening what social prescribing could be. She focused on cultural aspects, but it can be a range of other things, from having a cup of coffee in a neighbourhood group to participating in a gardening group or a memories group. There are a range of social prescribing models that will work, and what works will vary depending on the individual.

Crucially, what works will also depend on the volunteers who are available. A number of members mentioned the importance of volunteers for many groups, and it is correct that, across the chamber, we have recognised the value of volunteers in this area.

Sandra White and Annie Wells both spent a bit of time focusing on older people. We have provided £1.7 million to the Care Inspectorate to help care professionals to support older people in care to be more active in their daily lives. That is important, because we sometimes focus only on the early years. There are good reasons for that: it can appear that the easiest way to make a difference is in school and formal education; however, it is important that the whole of our society benefits from social prescribing, as appropriate.

Brian Whittle and David Stewart both talked about diabetes, and type 2 diabetes in particular. They are absolutely right that physical activity is a very important aspect of improving outcomes. That is why it is central to the diabetes framework, which has been roundly welcomed by practitioners.

There is another document that I suggest Brian Whittle read. He is normally good at constructive debate, but today was not one of those days. It is probably worth his while to look at some of the work that is being done in Scotland. One document that he should look at is the physical activity delivery plan, “A More Active Scotland”, which George Adam mentioned. That plan has been welcomed by the World Health Organization as groundbreaking.

When we talk about social prescribing, it is important that we find consensus.

I will make this point, then let Brian Whittle in.

This change is more than something that Government can achieve just by waving a wand or throwing money at it. What we are trying to achieve is a system-wide change. Liz Smith made the point that we need to break down the normal barriers—I think that she was talking mainly about barriers between different portfolios in Government and across local government, but it goes wider than that. What we are trying to do is not something that Government can do alone, so it is important that we come at it in as consensual a way as possible. The change will not happen quickly; it will happen over a period—probably several parliamentary sessions. As Liz Smith said, this Parliament has talked about social prescribing since its inception, in 1999. We are starting to see it happen, and the current Government cannot take all the credit for that. We have done it as a Parliament, together across the parties. Sometimes it is okay to come together and be a little bit more consensual.

Photo of Brian Whittle Brian Whittle Conservative

My frustration lies in the outcomes—and the reality is that we are the unhealthiest nation in Europe and the unhealthiest small country in the world. That is only being exacerbated. It is outcomes that are important, and, currently, they are not happening.

Photo of Joe FitzPatrick Joe FitzPatrick Scottish National Party

Oh, dear. The reality is that we have accepted that there are a number of challenges and we are taking actions to turn things around.

In terms of physical activity, something particularly unusual is happening in Scotland. Whereas people across the world are becoming more physically inactive, in Scotland we are flatlining. That is not good enough—clearly, we want to reduce physical inactivity, and our delivery plan aims to do that. We are on the right road and moving in that direction.

David Stewart mentioned rural areas, as he often does. It is important that we look at the particular challenges in those areas, but we have heard of a number of good examples from across the chamber, which I will come to if I have time.

I do not know how much time I have.

The Deputy Presiding Officer:

You have until 4.37. That is not long, is it?

The Deputy Presiding Officer:

It is another minute—I can count.

Photo of Joe FitzPatrick Joe FitzPatrick Scottish National Party

There are some really good examples that include rural areas.

Alex Cole-Hamilton, Liz Smith and Richard Lyle all talked about link workers, and they were right to note the importance of achieving the target of having 250 of those workers. Alex Cole-Hamilton talked about Muirhouse, and he is right—we are in the process of rolling out link workers there. It is not only the number of such workers that matters, but that they are in the right places. That point was well made.

George Adam made an important point about community connectors.

My time is almost up. The debate has been a good opportunity for us to come together across the chamber to reassert that we agree that this is an important agenda that we want to take forward. I thank the committee for all its work.

The Deputy Presiding Officer:

I call Emma Harper to close for the committee. You have until 4.45.

Photo of Emma Harper Emma Harper Scottish National Party

I welcome the opportunity to close this very important debate on behalf of the Health and Sport Committee, and I thank members and the clerks for their support. I will start by noting some of the key findings in the report and by briefly summarising the key themes of the debate.

During committee evidence sessions, one key point was continually raised by those who participated in the inquiry: social prescribing is not just another cost, it is an investment in a healthy and well nation. Social prescribing is a way to connect people to a range of local, non-clinical, services. As we have heard, the current model of social prescribing is generally delivered by primary care professionals, but the committee does not see why it needs to be restricted to primary care.

The committee heard how social prescribing improves health and wellbeing. That has been evidenced, and the evidence shows a direct link between social prescribing and improved health outcomes. The committee heard how promoting physical activity, through social prescribing, can improve people’s health and wellbeing. Such prescribing can be preventative in school and early years education, reactive throughout normal working life or re-abling through rehabilitation following other interventions to maintain independence and function in later life or in the self-management of complex and multiple conditions such as chronic obstructive pulmonary disease and other respiratory conditions.

The committee also heard how a focus on prevention and proactive care is crucial to supporting people to stay well, to manage their own health and to maintain their wellbeing to ensure that they can get help early.

One of the committee’s key findings was the need for access for all in local communities. That is important and will be highlighted in some of my comments on the contributions that other members have made this afternoon. I thank members for their speeches—I will pick out a few that are particularly worth mentioning.

The convener of the Health and Sport Committee, Lewis Macdonald, nicely summed up the committee’s work and report. The positive impacts of physical activity on physical and mental health are firmly evidenced, and health is the real wealth.

It was hard to find positives in what Brian Whittle said, but I agree with him that we can put type 2 diabetes into remission with weight loss and exercise programmes.

David Stewart constructively highlighted the social prescribing challenges in rural areas. As a South Scotland rural MSP, I identify with what was said. Liz Smith also touched on rural issues.

Alex Cole-Hamilton and Joan McAlpine spoke about social prescribing for other activities, not just for physical activities, and how mental health improves when isolation and loneliness are tackled. Joan McAlpine also aptly described culture, art and music in social prescribing.

George Adam described how community connectors have supported people in Paisley. Walking, swimming and engaging in many ways are obviously evident on his patch.

Liz Smith made a good point when she reflected on children creating menus in schools, which a previous Education and Skills Committee heard about.

Sandra White and Annie Wells talked about the benefits of social prescribing for older people. That is really important, because social prescribing is not just for young, fit and active folk or folk whom we want to get fit and active. Walking football is an example; tai chi and salsa have also been mentioned. I know that David Torrance is a participant in walking football. That is a good example, although I am reluctant to label him as an older person.

Mary Fee talked about preventative spending as a key to improving health and wellbeing and about access for persons with disabilities, such as to skiing at Braehead.

The contributions of Bob Doris and Richard Lyle, who are not members of the Health and Sport Committee, although Bob Doris is a substitute member of it, were informed and excellent.

I thank the minister for reiterating the roles and values of volunteers in his closing remarks and for supporting a system-wide approach to change.

The committee received a 12-page response from the Government, detailing actions that are currently taking place. That is really important. We are on a positive track, and we are making progress.

Just the other week, a members’ business debate that was led by Gordon Macdonald supported the Cheyne Gang choirs. It was highlighted in that debate that singing is a great way to improve lung health, especially for people with COPD. We know that singing can tackle social isolation—that has also been mentioned in this debate—that it helps people to manage their breathlessness and that it helps to promote social engagement. Some folk cannot even step out of their house because that can cause breathlessness, but we know that singing helps to support folk to live better and longer in their homes.

Given the evidence that we have taken, I want to highlight some of the key recommendations from the inquiry, although I know that I will not have time to go through all of them.

The Scottish Government should support NHS boards and integration authorities to invest in engagement work to raise awareness and understanding of social prescribing. Integration authorities should develop and roll out social prescribing awareness and education work, and social prescriptions should be treated on an equal basis with medical prescriptions. That will be challenging, but we know that prevention is a way to approach the matter. That has been highlighted especially when we have looked at the amount of money that the NHS currently spends on avoidable complications of type 2 diabetes. The Scottish Government, NHS boards and integration authorities should promote the wider scope of social prescribing and promote social environments, community assets and local connectedness as key drivers in increasing individual health and population wellbeing. We recommended that a spending target of not less than 5 per cent be achieved within two years—the convener noted that in his speech. Given that adults in the most deprived areas are the least likely to follow physical activity guidelines, the committee expects the majority of that investment to be spent in the most deprived areas.

The Scottish Government, NHS boards and integration authorities must ensure that voluntary and community organisations have the capacity and capability to provide socially prescribed activities. The Scottish Government must also review the sustainability of funding cycles, procurement practices and commissioning processes to allow community organisations to deliver social prescribing initiatives.

I am the committee’s deputy convener, and one thing that struck me in the evidence that was taken by the committee during its inquiry was the use of language such as “social prescribing”. I like the phrase “lifestyle changes”, which was used by Robert Davison when he came to give evidence. I also like “community connectedness” and Bob Doris’s description, “youth work and family work”. We know that different people will use different terminology to engage and support, whether they are participating in art and culture or playing walking football. Although I understand that medicalised terminology such as “prescribing” is a way for people to accept that social prescription is valid, a change of terminology has merit and should be considered as a rational approach.

I will finish by thanking all members—those on the committee and those who have participated in the debate—for their mostly consensual approach. I welcome the inquiry and its findings.

The Presiding Officer:

Thank you, Ms Harper. That concludes the debate on “Social Prescribing: physical activity is an investment, not a cost”.