The National Food Service: as a framework for social prescription.
Today one in five people going to the doctors are experiencing issues that are non clinical, with a rapid increase in patients needing referrals to psychiatrists.
“It used to be that around ten percent of clients referred to us saw psychiatrists and the rest were [treated with] psychotherapy. At the moment, around forty percent are needing to go to psychiatry” one doctor said, “I can’t keep up with those being referred”; the pandemic has created skyrocketing clinical issues.
Social prescription will form part of the drive to Universal Personalised Care that will see at least 2.5 million people benefiting from personalised care by 2023/2024, with at least 900,000 people being referred to social prescribing by 2023/24.
A nationwide social prescription ecosystem would need to accommodate an unprecedented scale of referrals. It would also need to take into account diversity, fulfil the need of personalised care, connect seamlessly with the NHS, and maintain a high level of quality control, as well as being free to use. This infrastructure does not currently exist and therefore represents a large opportunity for anybody positioned to create this.
In a recently published piece of research, exploring Social Eating Initiatives and the Practices of Commensality, Marsha Smith explains that “Social eating initiatives are a mode of food provisioning and eating that have become increasingly popular in the UK. These organisations provide low-cost meals prepared using food surpluses, and deliberately serve food communally to improve social inclusion.” In line with this, we in the Foodhall Project have found that a key discovery underpinning the social eating movement is that food insecurity, food waste, social isolation and social inequality are actually highly connected issues. These all relate to the decline of social spaces and services in our cities over the last 200 years.
The study begins to formalise the knowledge within the social food provision ecosystem that social eating “is a form of commensality, or group eating practice, which is not simply a consequence of reducing food waste or food insecurity. Instead these initiatives are enacted through a series of intersecting social practices, which include: the restructuration of the shared mealtime; alimentary contribution; and performances of care”. This means that food can be understood as the bedrock of a multitude of other forms and processes of social care.
The Foodhall Project has been a sandbox for new ideas in this area. Our output is not limited to food, and has provided regular art exhibitions, quiz nights, karaoke, gigs, and a communal garden and forms of pastoral care, with wellbeing officers. All of this is provided free at the point of entry, use and delivery, and signals a departure from the foodbank system; “they are not a source of shame — they are a second living room for those in the community”.
If social eating and food provision spaces can evolve, they could become the equivalent of a GP surgery for the social prescription system. Offering localised pastoral care and recreational wellbeing activities for those that attend, and who are referred.
One of the most successful ways of creating innovation in the social sector is to use action research methodology. We use this often in the Foodhall project as it is a philosophy of research generally applied within the social sciences.
Action research seeks transformative change through the simultaneous process of taking action and doing research, which are linked together by critical reflection. This way prototypes can be made that actively change society in a small way, while the benefits of those prototypes can be articulated as research and shared more broadly to allow findings to cascade. This culminates in the formation of new projects which comprise an eco-system of social innovation, and action research which the National Food Service network is developing into.
Action research can lead to prototypes of models for social prescription. These prototypes would need to accept referrals, accommodate needs, fulfil personalised care needs, connect seamlessly with the NHS, and showcase a high level of quality of social prescription. This work could be influential to emerging social projects across the country, and once crystallised it could help new projects that have emerged in the wake of Covid.
Between medical science and social science
One of the major shifts is that that we are moving towards a world where medical issues are being investigated alongside social issues.
Social prescription should be thought of as operating within the social sciences. It is not a study of health alone, but the broader study of human society, social relationships and how they intersect with health, and often how health and wellbeing is influenced by relationships among individuals within those societies. However this also opens up the possibility to incorporate and connect with other factors such as the built environment, and analyses of the social economy as wider forms of healthcare.
Today, social prescription vendors are fractured geographically, but collaboration is fundamental to all science, including the social sciences.
The current market might restrict the advancement of social prescription as collaboration is not the norm in the individualised nature of the economy. Unless we find a way to connect findings effectively within the distributed ecosystem there is a danger we could develop a non-scientific approach to the medical issues rooted in social causes. Without information connecting these valuable insights similarities between these fields may be missed and quality of these findings could be lowered as a result.
If a service that is wholly dependent on the existing skills within a local area then there is an enormous expectation for local voluntary groups to research and develop solutions to multiple complex social issues independently from one another. To give a comparison, this is similar to expecting every single doctor in the U.K to invent penicillin themselves before they can use it to help patients. The result is that the operational social sciences are in the dark ages compared with the medical sciences. In the long term these structural issue will develop into difficulties within the social prescription system, resulting in a lack of consistency in innovation.
There are also issues around how the NHS might partner with social prescribers, as NHS branches might have to conduct independent research into these prescribers or evolve satellite services before connections can be made between them. Many doctors, particularly in marginalised areas, will find difficulties in referring patients if an existing local ecosystem does not exist, meaning it will be difficult to maintain a nationwide service if social prescription systems remain individualised. For example, a doctor in Doncaster is at a significant loss when social prescribing compared to a clinician in a more culturally vibrant city.
Most providers of quality care will not operate for free, and some patients might have multiple complex needs that require bespoke care. This means that providers don’t align with the National Health Service’s ethos of being free at the point of entry, use, and delivery. Considering that one in five patients may need a social prescription in the future, after decades of cuts to public welfare, a new system is better developed from scratch.
Linking the National Health Service with a National Food Service.
The National Food Service network is a network of experimental social food projects, and is one of the few national networks that might position itself to be a key provider of social prescription services. Although it is in its infancy, if the NFS continues to grow and link groups, while following a pathway of local level action research it could grow a network of social food providers that also doubles as a network for social prescription action research.
By understanding food as an entry point for social welfare we can begin to make progress with physical health, but also tackle the simultaneous public heath problems like loneliness, social isolation and poor wellbeing.
The NHS describes a good social prescription scheme as one which enables collaborative commissioning and partnerships, provides easy referral from all local agencies, encourages workforce development, and one where link workers are employed to give time to people. It would co-produce personalised plans with patients and based on what matters to the individual, it would provide support community groups as well as a common outcomes framework.
“Social prescribing is a way for local agencies to refer people to a link worker. Link workers give people time, focusing on ‘what matters to me’ and taking a holistic approach to people’s health and wellbeing. They connect people to community groups and statutory services for practical and emotional support.”
This link concept also fits with sociocracy models; can we move from a single link, towards a ‘double link’ so that there are specialised workers within the NHS and the social eating projects can cooperate seamlessly. Ensuring patients progress is monitored, and the programme they are offered can change.
Long term thinking
There are thousands of social projects focused on providing food security. With the right models and systems in place some of the more receptive organisations within these networks could be trained to be NFS social prescription hubs.
If it is possible to make social eating prototypes locally we might build networks of social eating and food security projects, creating new modes of care that aren’t fractured, and whose quality isn’t defined by geography. Building an ecosystem of knowledge and an exchange between multiple social-eating enterprises will open a longer term wealth of knowledge that helps groups to onboard the National Food Service.
Moving towards welfare services which classify nutritious food and care as a public service, the NFS could play a large part in overcoming the enormous need for social prescription within the next three to five years.