Professor Sir Al Aynsley-Green was the first Children’s Commissioner for England and is a former president of the British Medical Association. An influential figure on children’s health and development for more than 40 years, here, Aynsley-Green debates the role social prescribing can play in modern healthcare – and advocates the power of community in improving outcomes for new generations…
Sir Al Aynsley-Green is in no doubt about the potential of social prescribing.
In 40 years of working to improve healthcare and development for children, he’s seen the movement transcend its long-held position as an outlier to being a commonplace term championed by the NHS including Matt Hancock, the current Health Secretary.
The former – and first – UK children’s tsar, who served from 2005 to 2010, has had plenty of first-hand experience of Whitehall’s limitations, and is candid about the struggles organisations that are passionate about social prescribing face.
He explains: “Social Prescribing is incredibly important but to make change happen, one has to work with the willing; those who are prepared to break out of the shackles of government policies and test new approaches in delivering services.”
Aynsley-Green has an unwavering clarity as to how social prescribing – essentially gifting primary care professionals an armoury of non-clinical services – can transform healthcare. It’s one gleaned from years of examining success stories from across the globe including early years care in Finland, and mapping children’s services by postcodes in Vancouver, Canada.
“We need to adopt a life-course approach to everything we consider, not just looking at the needs of the elderly but needs in childhood, in young adulthood, in pregnancy – it’s hugely important.”
And responsibility for such an approach lies ‘far outside’ the NHS, he says.
The African proverb: “It takes a village to grow up a child” sums it up well, thinks Aynsley-Green.
“It’s very difficult indeed at the moment to make changes via government central policy – there are such bunkers between the departments of state. We have to build local communities with resilient people at the heart, especially for children.”
He references his frequent trips to Canada’s west coast, where he’s seen the Human Early Learning Partnership (HELP) have real impact in Vancouver.
“HELP emerged at least 20 years ago when the city of Vancouver asked ‘where do children live?’ They didn’t know and they needed to know because of increased Asian migration. They took a map of the city and using routinely collected data they had already, they mapped the lines of postcodes using children.
“HELP looked at what was being spent on health, what was being spent on services to children and outputs, essentially mapping the lives of children by postcode.
“It was rolled out across Canada with extraordinary consequences. In Edmonton, somebody pressed a key on a keyboard and out came a print-out of the nurturative assets of children by school postcode.
“They knew where the creches were for babies, where the support groups were for parents, the youth clubs, the sports clubs for teenagers. It gives a snapshot for the life of the child by their postcode. That can be used to advocate and change services. We can apply exactly the same concept to mapping the lives of the elderly – why aren’t we doing it?”
While Aynsley-Green is clearly a dedicated supporter of the social prescribing movement, he’s also an advocate for backing up the power of it with solid metrics.
He explains: “How do we know it works? We need to start by having the evidence that this kind of approach actually does any good. The forum has to be be authoritative and evidence-based; at the moment we’re getting the dialogue going, which is important, but there are so many organisations who are unable to speak effectively for what they’re trying to change.”
He adds: “There’s an academic issue here – understanding the science of effective advocacy. We need to embed it in an evaluative culture from the outside and that means a clear strategy and metrics – it’s incredibly difficult but it shouldn’t stop people thinking about it.”
He praises the College of Medicine as “one of the very few organisations that’s prepared to look out of the box”, chastising the government, the Department for Education and the Department for Health for “surrounding themselves with people who think the same way as they do, which creates serious bunkers and silos to progress.”
General Practitioners need help to make social prescribing work on a practical, day-to-day level.
He says, supportively: “Primary care is the gatekeeper and one could signpost countless examples of excellent, outstanding care in practices and the people working within them despite political and financial obstacles in their way.
“Social Prescribing is potentially a very important tool – but where are the tool-kits? We can’t continue delivering services as we did 30 years ago. We need examples of it in practice, to inspire doctors and healthcare professionals to use it for themselves.”