Recent social trends such as an ageing population and the democratisation of information, through the internet, ought to be good news stories. So why are they creating new pressures on public service systems? Especially when, lifestyle medicine with its focus on nutrition, sleep and exercise over medication, is gaining traction. We’re living in a protracted era of fluidity and liminality. And these two paragons of uncertainty are, for the time being, the reluctant foster-parents of a newly-born world order.
In 2017 the Conservative government announced a new policy that would require GPs to offer patients access to activities like art classes, singing lessons, exercise classes and other creative pursuits. More recently, the National Academy for Social Prescribing was launched to oversee standards, help share best practice and bring together partners. Let’s suppose the timing has nothing to do with the December 12th election, and the NHS for once is not in any way shape or sense being used as a political football. The concept commonly referred to as “social prescribing” has got tongues wagging, and there are some who are taking umbrage with the language; “prescribing” being the offending word.
Communities Don’t Need Labels, Structures or Models and That’s Good News for Primary Care Services
This development raises the question of how statutory services connect more meaningfully with value-generating community assets to form new partnerships for prevention and wellbeing. It also posits whether it’s even necessary to do so when communities, by definition, are the natural breeding ground for creativity, entrepreneurialism and life-craft. If you’ve ever given the question serious thought you’ll know it’s not so simple as it may seem.
Taking the long-view, we can parse back through the recent iterations of integrated service models; multi-agency working; social impact bonds; not-for-profit community trading vehicles; and statutory instruments like PFIs. In fact, as early as 1887, Ferdinand Tonnies framed an idea about what happens in the chaotic, intangible space when society and community (roughly translated) necessarily intersect. Max Weber later posited a similar idea as a framework for dramatic social change.
It’s Getting Harder for Government to Connect With Hearts and Minds – the Information Highway is Congested
The muddled middle is a cloudy, complex place. It represents the uncountable, often invisible, human interactions that occur right under our noses in the street where we live. Chats over the garden fence; the laughter and smiles in pubs, clubs and coffee shops; chance meetings. It’s the place where people come together when and how they choose to, or not. This hinterland is also the home of the swing-voter and therefore the sweet-spot, come target-zone, that politicians aim for when messaging for votes. Slogans, models and structures cannot easily capture the totality of this dynamic, and therein lies the rub.
A colleague once surmised. ‘surely this is just people living their shitty lives. What can we do about that?’ She then added, ‘I like working here because the pay is unbelievable and you can keep your head down and do as little as possible.’ Granted, that’s an understandable point of view when you feel the odds are against. But it’s also the same space where you will find, if you look carefully, a 93% correlation between high rates of smoking, alcohol dependency and debt-stress in the population who live within walking distance of not 1, but 3 or 4 betting shops. With a scientific lens, it is possible to pose a simpler question that leads to the same solution as a complex one (Occam’s Razor). And this could be a useful tool to see beyond the smiles.