Social prescribing

‘Social prescribing’ benefits both patients and society. Some prescribing however, whilst benefiting the patient might actually be viewed as being ‘anti-social’. We anaesthetists have recently become aware that our ultra-stable and ‘ultra-clean’ volatile anaesthetic desflurane is in fact far more environmentally damaging than other similar agents. The slightly faster wake-up profile comes at a pollution cost to the planet equivalent to burning buckets rather than bottles full of petrol. An invisible but real inferno in the operating theatre.

And our more liberal use of strong opioids to manage postoperative pain following early discharge from hospital. Often effective in the short-term and well-meaning undoubtedly, but perhaps one of the factors responsible for promoting long-term addiction, misuse and social misery.

Just as we need to think about ‘social prescribing’ we should also consider the possible ‘anti-social’ consequences of the medicines we use. We need not only to care for our patients, but also to look after their children and grandchildren.

I read this article with contentment but with worry. What the author is describing I trust is common remit of social workers attached to healthcare settings (and not exclusively, also in Primary Care). I myself have been doing this since 1994 and it is a pillar in my role in the Memory Clinic where I work. Social prescribing was not singled out and newly named, yet an integral part of the role description of a social worker.

I am delighted to see the spotlight placed in how social determinants have a major impact in health outcomes. Also in the fact that the bio-psycho-social approach to health care is realising the importance of the psychological and the social aspect in its very own name. The WHO in 1948 defined Health as "State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity” Yet we are still to this date having to emphasise how social determinants are key to health.

Social workers work from a Person Centred approach. We embed this person centred approach in a systems approach and from there we work on a life-course approach to health, including education, healthy eating, exercise, limit alcohol, no smoking, socialization, mental stimulation, good sleep, good mental health, availability of talking therapies, family support, support to families in crisis, support with social welfare/income as part of a plan for change, signposting of services, and this is by no means exhaustive.

The predecessors of medical social workers, the lady almoners, in the middle of the last century (1948) were already trying to address similar issues of recognising of their roles.
Aneurin Bevan, Minister for Health in the UK at the time, addressed their AGM in 1950, saying:
"The work of the doctor must be reinforced by the work of the Almoner, for it is now recognized that it is not possible for even the most skilled medical service to have its best beneficial effects upon the patient if he is harassed by domestic anxieties and by fears of the future that intelligent activity can remove. Therefore the Almoner has become a very important part indeed of the modern healing work."
"If a protest is not made, it seems to me possible that the almoner may come to be regarded merely as an assessment officer & as such relegated to work of little importance or even abolished.
She may have been reassured that the research & hospital work role of the
almoner would not be assigned either to the medical profession or to health visitors. (1)

So here is my protest of sorts - I wholeheartedly agree with the need of social prescribing. Just do not invent new names for the most adequate professional to administer this. Use the Social Workers you already have.

(1)(Aneurin Bevan, The Minister of Health Addresses the Annual General Meeting
The Almoner (April 1948), p. 5, MRC, MSS.378/IMSW/A/17/9/1)