Hansard

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.