E65 - Are We Ignoring Loneliness? (with Prof. Dame Stokes Lampard)

Professor Dame Helen Stokes-Lampard is a British medical academic and a medical general practitioner. She is Chair of the Academy of Medical Royal Colleges a GP principal and Chair of the National Academy for Social Prescribing (NASP). She was Chair of the Royal College of General Practitioners (RCGP) from November 2016 to November 2019.

In this episode Anya and Helen discuss the impact of loneliness, lack of meaning and spiritual needs can impact people's mental and physical health. They also discuss different means these problems can be addressed, including the concept of social prescribing.

Interviewed by  Dr. Anya Borissova.

National Academy for Social Prescribing website: https://socialprescribingacademy.org.uk/resources/

If you’re interested in becoming a link worker: 

1.https://www.nalw.org.uk/
2.https://www.england.nhs.uk/personalisedcare/workforce-and-training/social-prescribing-link-workers/

Prevention is better than cure podcast: https://podcasts.apple.com/gb/podcast/prevention-is-the-new-cure/id1673584286

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Transcript

 So hello professor Dame Helen Lampard. Thank you so much for joining us on the podcast today. And and welcome. 4s Absolutely, absolutely. Thank you. So I'm hoping that we can today have a conversation about social prescribing, your work, chairing the Academy for Social Prescribing, to think about your work as a practicing GP and to think about your work also looking after GPS in your previous role and as the head of the Royal College. I hope that we can explore what social prescribing is, who it can be for, how this idea has come about, how you see it work in practice, and any other directions in which this takes us. 1s To start. 1s Plenty to cover and to start. Love. Just to get a sense. For people's journeys. To walk to where they've. To where they've come to. How they've got interested in the things that they've got interested in. And so I wonder if you could share with us your path to being a GP, because I know you went, um, a what's the word? You had lots of different ways, so I can't say that word. So that's the problem. 3s Um, but what what what attracted you? What got you interested? 620s I mean, I'm tempted to to let you run on the thread because I guess there are things that are flashing in my mind, but think we can come to them and we can see where it goes, I guess. Yeah. Tell me more. 122s You. 135s Mm. 2s Thank you for that overview, because I think that just gives us a flavor of what's happening. I guess I wonder if I could go right back to the start to, to this point that you made that about a fifth of general practice work. And, you know, the the work of general practice often is managing these issues that aren't prescribing hypertensive at all a clear medical problem. And the work that you did, you did with Enid. Enid was, I guess, the opposite of medical izing something. It could be argued, but so what? What do you think? What do you think about that figure? That the 20% a fifth of work isn't can kind of fall into this category, that social prescribing can help? 267s Mm. 1s How do you think the feeling that came up in me as you were talking was a sort of recognition and and identifying with, you know, the complexity that you are greeted with of problems that you feel like you can't, you don't know how to deal with them or you you recognize that they're a major problem. You know, somebody can't pay their heating bill. They there's problems at home. There's worries in the family. They of course, they can't get to the gym. When will they have time? And you just feel this barrage of. 2s Of course. You're so right to the patient. But how do I help you? Where do we go? How do you manage that? 227s Mm. 1s And I'm curious about the point of the changes in the way that our communities are set up, or even perhaps the the loss of community through less focus on religion, less space for religion, less interest in religion, 1s other just communal living more generally, I guess having, you know, a village hall that everyone gathers at or having village productions or, you know, a few of my friends had that growing up where they'd take part in the Village Musical, but it was few and far between. 1s I guess as someone who very much works in is embedded in the community. You've seen that, I mean. 1s Why? Guess. Do you think this is the move that's happened in Britain? And also are there? I hear a lot more conversations that emphasize the importance of community. Is there a sense that our change, our thinking is changing or thinking is moving away from this individual? Everyone out for them or not, everyone out for themselves in a negative way, but everyone's just their own person. They're not part of anything. Is that changing? 265s Yeah, yeah. 2s And, you know, have an exactly t t up and. 1s I mean, I'm again the thought that sprung. So one of the criticisms that I've heard about social prescribing, or maybe one of the concerns raised with it, is that it is medical izing things that, you know, that should just be left to normal life. Um, and the and I think there are there are issues that we can pick about within that criticism by itself. But but again, how do you think about that if when people come to you with that as a concern? 87s Okay. 138s Yeah. 1s Oh. Guess within. Within that realm. Mean, how do you think about equipping people for the skills and even not necessarily as a GP, but if you're thinking more broadly about society. What kind of thoughts do you have within the prevention world? 6s I guess maybe let's not split it up. Let's think. Yeah. 315s Mm. 2s I'm interested about the older generation point, because I guess something that we learn from our exams in psychiatry is some of the theories of life course. What are the kinds of things that one should be doing at the different points of one's life in order to, 2s to, to feel like your life is meaningful as opposed to feel a sense of stagnation or despair or etcetera. And and it's something that I think that you touched on with Enid about this idea of giving back, feeling like you have knowledge and wisdom to share. Purpose? Of course. 1s What what is your work with older people like and how what is the social prescribing work with with older people like? 197s Mm. 1s If there's people listening who say 1s or are doctors, professionals working in other parts of health care or indeed is someone who thinks, oh, I'd love to get my aunt or my, you know, my neighbor, suggest this to them. Where where would you point people to to learn more or to understand oral? 1s Figure out what's available locally. 1s So. 148s And. One important question that I missed, and I'm going to ask quickly before we finish is how, in terms of finances, how does it work if people don't have the financial resources to do the gym or the activity that suggested or that's come with. 113s Yeah, absolutely. Helen, we've we're coming to the end. And thank you so much for your time. Guess if people want to hear more from you specifically, you've mentioned your podcast. Where else would you point people to if they want to learn more about your work or your thinking? 47s Lovely to meet you too. Thank you so much. 2s At the end. 133s Oh, it's lovely to be here. Anya, thank you so much. And please call me Helen. 16s Mhm. 20s Of sounds great. 1s Plenty together. 22s So you could do it's. 4s Wonky route. Yeah. 5s So I did have a slightly odd route into general practice. But but one of the things that I use a lot as an example to people at different stages of their career, how there are no wrong decisions in medicine in terms of your own career, and there are no times wasted doing something that you ultimately don't end up specializing in. So that's a takeaway for some people. Hope that's helpful. So I saw you pick up the Welsh accent. I grew up in South Wales and went to a reasonably tough comprehensive school. Didn't know if I was bright enough to study medicine. It was only really when I had my O-levels that dates me because was the last year of O-levels, and the people start saying, so you are going to apply for medicine, Helen? Um, so had a kind of slight up to that point. Things were different then from where they are now, but I'd been thinking of my high aspiration had been dentistry. But then the sudden realization that medicine would give me even more options than a dental qualification would. So. And at that stage, some of the experiences, you know, everyone knows their GP as they're growing up. But the other medical experiences I had were sort of through Guinea cancers, through family, friends. And so Guinea Oncology struck me as having an amazing balance of both medicine and surgery. And I knew I loved both the technical, analytical, practical, but also really interested in people. So whatever I was going to do in medical school was going to be very people focused, but also quite practical as well. So nothing in medical school dissuaded me that gynaecology was a good way to go. I knew that every time I had hands on a patient, that was that was the bit I enjoyed best. I was never going to be a lab scientist, which is absolutely fine. You know, in a sense, my assumptions about myself were reinforced. Also in medical school, I got involved in medical politics or medical student politics, and I had always come from a family where our sort of family mantra is don't just whinge, do something. So if you're not happy with the situation, seek to fix it. Don't just be a moaner on the side. And so that sort of started in schooling and carried through into university. When I emerge, I started gaining oncology as my training path, or gaining any OBS and gaining sort of the general training path. But this was in the late 1990s, and there was a lot going on in training paths at the time. I also got married quite young, um, had a few life events, and I found myself in the late 1990s having a career swerve and realising that I was the, you know, there were there was no career progression. And obviously at that time we'd all been written to by the college saying they were going to be they were pausing career progression for five years at least. There was an oversupply of trainees. And we could go to Belgium or Canada if we wanted to. They were looking for trainees. Um, and I'm fairly stubborn and in a sense that in itself wasn't enough to dissuade me. But the combination of that and quite a few other life events and and I think the realization was starting to get a little bit bored, and I was allowed to take patients to theatre in the middle of the night. I wasn't allowed to take patients to theatre on my own in the day. You know, the sort of stuff that can happen when you're in that training grade thing. And I was particularly because I was interested in oncology, I was in, you know, quite a specialist couple of jobs, and there were a lot of people fighting for theatre time and so on. Anyway, made the decision and so decided, well, I had loved public health medicine when I was in medical school, and so I was decided, right, if I'm not going to cure them one by one, I shall clear cure. The whole flipping lot of them will do public health medicine. And that coincided with my husband relocating to the Midlands with work. He's an engineer. And so I contacted the West Midlands and said, hi, I'd really love to train in public health medicine, what do I need to do? And they were absolutely lovely and very, very supportive about it all. But they basically said, like, you need some experience in general practice and then we can give you a training number because you've done some research focused jobs, you've done a good range of things that would count, but you really need GP. So I contacted the West Midlands dean and he said, hey, how do I get some experience there. Dismissed the recruitment round for a year. Oh no. I'm going to stall a year. When you're at that stage of your training, a year feels like an eternity. And but then somebody said, but you know what? We've got these amazing academic general practice in innovative training posts. Why don't you apply for one of those? It'd be amazing. Foundation for Public Health Medicine applied. I got one and the rest is history. Because within weeks of starting as an academic registrar, I just found my happy place. It was that amazing combination of having a long term relationship with patients, as well as the shorter McEachin had the urgent and you had the chronic, you had lots of patient contact, and you had this incredible insight into people's lives, and you could take a much more holistic view of patients, which is, I think, realised that something I'd be missing in secondary care had been that big picture view of understanding the communities in which people worked, the other things that impacted on their life. I'm going to fast forward quite a chunk now because this isn't about my medical career, but thought that might be an interesting thing for some people listening. I continue. I told you I was interested in medical politics that continued and that I found myself in 2016 elected as the chair of the Royal College of GPS. So the has a different structure from most of the other colleges. It has the same structure as the BMA and that it is a chair. Who is the political policy lead, also the figurehead that you would see on the news and so on. But there is also a president in the Royal College of GPS who's a much more ceremonial role, sort of the Queen of the King, rather to the prime minister relationship. Um, and so the president has shorter terms in the Royal College and indeed the phasing out the that, that duality. And they're going to go for the same model as other colleges do in the next few years. So service chair, the quite young relative to some people doing the job or not, the youngest certainly will need to be a woman doing the job. It has been done by several women before me, so that wasn't inevitable. Although I had been the first female treasurer of the organisation prior to being elected chair and during my time as. Chair. There were a huge number of challenges. I mean, certainly the challenge city psychiatry has faced about being treated like a second class citizen in the medical world, you know, sort of speciality that wasn't as popular as some other specialties, but also a lot of political misunderstanding about what good general practice really is. And so we fought a lot of battles. And during those battles, I had to give a very big speech on one occasion, and I used an example, a narrative example of a patient of my who I called Enid, 1s who had made me think differently. And the point of the speech was actually about the problems we have with protocol driven, driven tick box medicine and GP's particularly. But plenty of other parts of medicine are pressurised into doing, you know, computer science type medicine. You have to take these boxes to get paid or to get resource or whatever, or to prove you're being good, doctor. And that's very deep professionalizing, demotivating. You spend time looking at the screen, not the patient. So I use this example of Enid, who I had not followed guidelines for. I had I had basically helped Enid with her problems by doing what we would now call a social prescription. Essentially, she was she was feeling lack of purpose in life. Her husband had died. She actually grieved appropriately. She wasn't having abnormal grief or anything like that, but actually without her husband, since she, you know, she'd been with since she was in her teens and they'd always been a double act. Actually, she had nobody to say hello to in the morning. She had no reason to do because she had a wonderful family, but they live a long way away. So she didn't have the hands on grandmother duties. But I connected her with a local organization that was matching her. It was like a rented granny thing where you were matching up single mums with experienced women to give the younger members a bit of confidence, a bit of education about how to run a house, how to look after kids, how to be a confident mum. And of course, it was giving the older women a sense of purpose, of giving something back. And it just transformed Enid's life. She certainly had purpose in her step and for me as a GP, this incredible moment came where she walked back into the consulting room and she'd had her hair done and she had makeup on, and she hadn't done those things for perhaps 18 months. 1s In the time I'd seen it before. Since the husband had died. And it was just so. That was a really powerful moment as a of didn't do GP stuff, didn't do medicine, didn't give her drugs, and ironically, because she got purpose back in her life, she didn't need antihypertensive. I never ended up preferring her to get a hip replace, because actually she was more active and dynamic and she she, she created her own physio. And so the things she brought come in to see me for got fixed through her having a fulfilled life. 2s I'd say that wasn't the point of the speech. The point of the speech was about having the courage to go off the tramlines. And they, they they they're not tramlines. They are guidelines. And we are as GP's and all doctors, we should. Our strength is in our ability to go outside and beyond. But this really sparked something amongst GPS because they recognized in it in their own patients. They recognized a huge part of what we do is not about the physical or indeed the psychological. It's the social and spiritual part of people's lives. And evidence tells us around 20% of what comes through the consulting room door is socially based. So whether it's and people have financial worries, whether it's because they're lacking in purpose, whether they're lonely and so. People who are already in the social prescribing movement approached me and said, Helen, this is this is what we're talking about. So what is this word, social prescribing? It's a bizarre descriptor. What does it mean when I'm writing a prescription? This is just silly, but I've come to understand that for all its flaws as a term, social prescribing is what good GP's have always done. It's also what hairdressers, bartenders, religious leaders and anybody who really cares about other people has always done that help people find the right solution for their problems. It's helped connect people with what's out there, and there are a lot of myths about social prescribing. But basically that was the moment, the turning point for me. I should probably pause there because you're sitting, nodding along, but. Do you want to pick up on what I've said? Carry on. And you? 13s Okay. 2s Okay. So this was probably about 20. This is 2017, 2018. And I started getting genuinely interested in this concept and realized that what really gets me out of bed in the morning is providing truly holistic patient care. I've remained a frontline GP throughout all the other crazy things I've done in my life. I'm still a partner in a surgery in the Midlands and it's the totality of care. Not just treating the hypertension, not just identifying the depression help manage that. It's the big picture stuff, which of course GP's are very well placed, but there are loads of other places in medicine where people are uniquely placed to do this stuff. So psychiatry, A&E, goodness knows and people in all their social challenges, not just their physical and mental ones and care of the elderly, a lot of medicine. So anyway, I got interested and then I was like, and we did. There was a lot of work going on for a new contract in general practice. And Simon Stevens, the chief executive. The NHS in England then became interested in the concept and and a couple of amazing people in NHS England also really got it and we managed to get NHS England to commit to put social prescribing link workers, i.e. the people who do the the stuff better than GP's ever could. As a GP, I've got a black book of addresses and numbers and things that I signpost people to, but a proper social prescribing link worker has the time to really understand what a patient needs, and the time to take somebody by the hand, metaphorically or physically, and go with them to a class, buy them or find them a pair of trainers to get them going and exercise and not just say, here's a number. You should call this because actually many people haven't got the ability to take that first step. 1s So anyway, committed to the NHS in England being the health first healthcare system in the world to put health resource into social prescribing, recognising that link would ultimately end, you know, being quite brutal about it, to take work away from the NHS and allow GP's to focus more on doing what only we can do and to do less of that step. But knowing it was being done better by others. 1s So we got that into the contract, which started in April 2019. I finished my term of office in November 2019, and in sort of summer 2019 was approached by the Secretary of State for health, then Matt Hancock, who was very taken by the whole concept and was definitely been convinced that this was a helpful thing to do, and said, Helen, we're putting money into this contract. We have to justify, we have to make sure the evidence is there and this this needs a responsible footing behind it and prepared to find money from budget for a new body to be set up, but some sort of social prescribing organisation that will effectively be a bit of a cheerleader, set standards and make sure the evidence is coming for less. Well, do you fancy helping us out? I said, well, I can't do it till I finish it. The GP said, no, no, that's fine, that's fine. You know, you're finishing soon. I'll let you know what. That might be quite fun. So there were three of us asked by Matt to do this, two people to manage this, England and myself, the two from NHS England, James Sanderson and Bev Taylor, were seconded from NHS England for some time to do it. I was just doing it in my spare time. There was nobody for me to be seconded from. There was no money for me to do anything. So the three of us rolled up our sleeves and set up an organisation from scratch on the promise that we'd get some money eventually. It took took the best part of a year before we got a penny, but we set up the National Academy for Social Prescribing, turned it from an idea into what's now a flourishing registered charity and the organisation. Basically, it's the organisation that championed social prescribing, and we want people to live the best life they can and we will work with others. We will link others to make that a reality. Recognising the money for link workers is coming from England, but local governments have been supporting this kind of stuff for a very long time, but in a very ad hoc way. We're providing a bit of structure and standardisation to it, and also busting a lot of myths about what it is and isn't. And, you know, it's been quite the journey. So I went from being one of the let's make this thing happen to the chair of the organisation and then chair of the board of trustees. Now, as we're a fully registered charity. So that's my role, which is actually a lot more hands off than I used to be. But I've got to meet some cool people and do some cool things along the way. 12s When? 11s Yeah. 10s Yeah. 7s Yeah, that's. 3s So that feels about right. Mean, essentially what that means is that in most of the more than half a consultation, something is part of the consultation, which isn't strictly medicine, as you and I will know it. Um, so, you know, classically a patient, I mean, sometimes people do come in and they have literally stubbed their toe, or they've got arthritis in their knee and there is nothing else going on. But, you know, most of the time people have complex, messy lives. And, um, you know, a typical consultation for me will be, let's take somebody, a middle aged person will come in and they're having very odd pains. They're tired, they're having very odd pains. It's all very non-specific. There's no red flags saying, oh, I'm this could be kidney cancer or oh, this could be, you know, angina. It's all vague and a bit messy. And so, you know, we might spend a bit of time asking what they think might be going on. We might be talking about doing some basic blood work, you know, to look for the normal sort of stuff you have. They develop diabetes if they've got a thyroid problem and anaemic all that. That's what I'd call fairly baseline stuff. al-Assad would always be wanting to ask about their emotional state and their mood. Is there is this actually a manifestation of depression or anxiety disorder? But what's much more likely to come out than than a sort of clean cut diagnosis of mental health disorder is actually that they are stressed, their marriage is on the rocks, or they're under stress at work, or their company's merging, or they've got a teenager who's got an eating disorder, or they've got an elderly parent that they're caring for. And so, you know, stress is, you know, that sort of level of the pressures of normal everyday life. You know, how much of that is truly medical, how much of it is social? A lot of that is social. You know, if if there were better care systems and things available for their elderly parent, they might not have that individual stress. It's the knock on effects of other parts of the system. 1s For other people. It you know, money worries are a really big thing. Mean obviously the pandemic was a huge specific set of stresses and it's left in its wake. A lot of people who are financially more pressured than we've known them for a very long time, and that's the reality. And and those who are already only just about managing are the ones in the most precarious position. And, you know, sometimes it's very easy as healthcare professionals, despite all the challenges and pressures and the debates and everything we have about remuneration, terms and conditions, ultimately we are definitely the doctors are the better paid end of things. And we I'm pretty sure that you and I don't have to worry about how we're going to pay our heating bill, or how we're going to put shoes on the kids feet to get to school. And I'm not talking about people who are in genuine Covid. I'm talking about people that just about managing, rather those who are above the thresholds, where they don't get any benefits and are often the ones who struggle most. And those are the people who I it's just it gets me to the core every time when they look me in the eye, when I wanted to prescribe something and say, doctor, you prescribing two things, which of these is the more urgent? One, because I can only get one until my next pay packet comes in, you know, and okay, other parts of the country have got all free prescriptions and that creates other issues too. But. 1s There are things, you know. You see it all the time. To be a good doctor, you have to be so much more than being a well-qualified, intelligent physician or a good psychiatrist. It is. It is much more than that. And, and but it's also recognizing what the limits of what we can do are. I can't be my patients friend. I can't be there. Be friend. I can't be the solution to their loneliness. But if I identify that their loneliness is a major factor and causing them harm and is amplifying the pain they feel from their arthritis, or is, you know, their low self-worth means they're not motivated to exercise, which is exacerbating their joint problems. Then once I've got that knowledge, then if I can do something about it, I will help turn that patient in. I can empower the patient to try and take some ownership. I can help put a true fix in as opposed to a sticking plaster. So much of what we do in the NHS is sticking plaster medicine. We patch them up and send them off, but we know they're going to come straight back to us. Whereas if we can get to the root cause of the problems, which is where a lot of the social and societal issues lie, we can we can genuinely start to turn people's life around. 25s Yeah. 8s Yeah. 8s But yeah. 2s And where do we. Yeah. And I think there is something about where we draw the lines and think different disciplines in medicine are going to draw the lines in different places, quite appropriately so. And think as a GP, because we're embedded in our communities and generally we have a lot of insight into the peculiar challenges of these particular streets or these particular communities within our patient population. And they made that point. But I can't be my patient's friend. That's not my job to be their friend. But if they meet, what they need is a friend, then helping them find that friend and is is both incredibly rewarding to me as a professional. It gives me satisfaction that I'm providing truly holistic care but also to the patient. It can be size, make it the difference it can make to them 1s and that and then seeing them need less medical care when they're getting the right sort of social or spiritual care. It is is helpful. And I think we, you know, society has evolved very fast. The pandemic pushed us forward in a sort of a quantum jump, didn't it, in terms of things, you know, moved online, the virtual space and so on. And it left a lot of people behind and created a huge amount of harm and think, what's happened is we've had an acceleration of those harms that were already inherent societal shift. So I'm thinking families, you know, the lack of generational support across families, you know, an awful lot of people don't live near their parents or their grandparents. And so younger people who leave the area where they've got all those social networks can be incredibly lonely and isolated. And the virtual, the having a hundred friends on Facebook is no use when the fuse goes in your flat and you have no idea how to fix a fuse. Yeah. So. 1s It. Actually, my family of the frame. The phrase a Facebook friend is is actually not a compliment. It's oh, they're just a Facebook friend. As in there's somebody will happily give you a thumbs up when you post something funny, but they certainly won't be there when you need help. Um, so there's something about genuine friendships and what people really need. Obviously, social media can be a massive force for good for Sam, but we know, again, for young people the destructive harms that can come from unrealistic expectations. The shift away from religion has certainly exacerbated problems for many because religious groups or doesn't matter what faith or denomination. Almost all encourage a sense of companionship, of support for one another, a community to be part of where you're valued for who you are, not what you do. And again, the shift away from that has left a gap or at the start said, you know what, really? Religious leaders have always done? Good religious leaders have almost always tended to the whole person. Mean obviously they've been there for the spiritual, but the good, you know, religious organizations do a whole heap with the social. And for they also do the mental health and the physical health as well in practical support and, and the way our towns and structures are built. You know, we're not built. We don't build villages anymore. We build tower blocks, we don't build communities. And there is something I think this isn't the space to talk about sustainability and environmental challenges. But actually, as we look to sustainable living, what's good for our planet is almost always good for our health in terms of how we plan. So whether that's villages and towns that build sense of community, but also encourage people to walk and cycle and have green spaces, those are incredibly good for our wellbeing in a wider sense. They're also good for the planet in terms of we needing to cherish our green spaces and encouraging people to live healthier lives. So there's a huge interplay here, which is very much of our time. 17s Yeah. 6s Yeah, absolutely. 2s Yeah. 26s Me. 8s Yeah. 4s I think. Yeah, I think probably the pandemic and the sense of community that was engendered and realizing we had to look out for our immediate neighbors, people who had never spoken to each other as neighbors suddenly spoke to each other. We met on the roads, whether it was clapping for the NHS or whether it was realizing, is that vulnerable person? I mean, I know there's an elderly, frail looking person a few doors down from our never spoken to them. I don't even know their name, but hell is anyone getting them food. How are they coping? You know? It was a work in the sense of community that perhaps certainly we hadn't had it to that magnitude since the Second World War. I mean, I remember it in the 1970s, as a kid in the late 1970s when we had two bitter winters with very deep snows. And neighbors help neighbors. We looked out for the vulnerable, our communities in a way we hadn't before. And so to me, it brought back a lot of that spirit when we had the lockdowns. So I think I think, yes, the pendulum started to swing as a recognition that we are really missing something, but it's hugely variable when you travel around the country, mean the National Academy for Social Prescribing does most of its work in England, although we are fully intending, you know, our aspirations to be a four nation organization. We have a very strong links globally. We've got links with at least 25 different countries around the world where social prescribing is really taking off. And there of, you know, quite a range. Although there's more talk about this in northern Europe and Northern America and so on. But, you know, it's in Australasia, it's in parts of South America, Africa and so on. It's taking off. But. 1s I'm sorry I've gone off points. So I said the community side of it. This is a generational societal drift that's been happening, certainly not exclusive to the UK, but also the recognition that there is another way of doing things. If I raise a slightly different way of thinking about it, one thing that I've certainly become to appreciate more as I've thought about and been involved in this space, is that what we're talking about here is almost an eastern way of thinking about medicine. If Western is the sort of biomedical, eastern has been very much the spiritual, holistic side of it. And this is a sort of marriage of the two. This is the recognizing the merit and merits of each and the risk of the sort of the biomedical of the perhaps 1970s, 80s is that you you have left out the person, the spiritual side of them. They got left of the door of the hospital or the door of the consulting room, the eastern side. You know, there's lots of things used and sort of herbs and things used that actually aren't rooted in, you know, good. What we would call good science. They certainly don't pass the gold standard, double blind, randomized controlled trial standard. But there's a huge belief in that things are going to work. There is a massive placebo effect. We've got the nocebo effect. And actually understanding that those are hugely important, that people feel valued. And the medical community has been very sniffy about an awful lot of alternative therapies. And of course, we know a lot of them were because they were by giving people attention, by caring about people, but thinking more widely than it's it's not going to be the warm stone or the nice smell that does the trick. It's the attention and being cared for and valued and validated as an individual and think we need as a medical community to have a lot more humility when we think about these things. One of my roles, one of the reasons Matt Hancock asked me to chair the organisation was because am a professor. I have a research background, and that gives me a little bit of authority to be able to say to people, hang on a second, don't stop being academically snobby. For want of a better word about the research paradigms we use, there are sometimes for a complex social intervention. You do not need a randomized, controlled, double blind study, because that is that has to be controlled in 1 or 2 variables at a time. You can't do there are hundreds of variables in the average social prescription. Therefore, you need to be looking at social science models. We need to be learning from our colleagues in the social sciences and think that shift in how we think and evaluate things has been helpful to. Of course, if we can get cost effectiveness analysis on big prospective studies, that's fantastic. But that is expensive and takes a lot of time. I don't think anybody is going to argue with a massive wealth of evidence that just about all physical activity is good for you, so, you know, we've done within sensible parameters. It's then how we apply it to the individual. I'm going to take a breath. 2s Right. 37s Yeah, I think that's completely legitimate. And I think there is a lot of stuff that has been done under the umbrella of social prescribing, but I wouldn't recognize as such. And I do think, you know, it is not a snooping charter to get into people's lives where we're not wanted. Think this is a recognized you know what? I think one of my questions to somebody, if I were to be issuing a social prescription is a 1s what? Well brings you satisfaction. Where? Where do you get joy in your life? Do you know the number of people when you say to them, what? What brings you joy in their life? Look a completely blank. They don't know what brings them pleasure anymore. They haven't thought about that for such a long time. They don't know what makes them feel fulfilled. And that's that's really sad. You know, life is short. And if we can't get fulfillment and satisfaction and joy in our lives so well, when you do start to unpack it with people, 1s you know, what's interesting is how diverse the range of things is. You know, what can you know? Looking at a beautiful piece of art can bring one person. Huge satisfaction leaves somebody else completely cold. And in the same way, our tastes in music and. But actually there's a map tracking, you know, it's a reflection of how diverse humans are. So in terms of interviewing people. Yeah. No, I agree, as a GP, I haven't got the time. It is not a good use of my resources to sit there asking somebody if if they would like to listen to Brahms or death metal, that's not my job to do that. But if they have come into my consulting room and I'd recognise there is a deep darkness in their life which keeps bringing them back with minor, relatively trivial complaints, which to them, or organic, which to me have no organic basis. Then we are wasting my time with the time if we don't try and address some of that stuff. And it's infinitely better for the individual if we can help them in that way. So that would be my response. Yes, of course, we must be cognizant of our roles as healthcare professionals and what we're paid to do. 2s But in the medium to longer term, there is no doubt that if we address the underlying causes of problems, we will be better for the individual and better for society. And that takes me on to another area which is very interesting, very big, important to me, in which is prevention, disease prevention in the wider sense. 1s I actually run a podcast called prevention is the New Cure, where I, the chair of the Health Select Committee, Steve Bryan MP, and I do a podcast where we talk about things that are political and health. So all things health with a political twist. And recognizing that getting all the political parties to understand the prevention is infinitely better than cure, if we so much better to prevent disease and that applies to mental health issues and how we help people be more resilient and understand what normal experiences are and how to deal with the normal range of human conditions. You know, we will all experience grief, we will all experience loss, we will all experience rejection. And it's how we give people the resources to deal with those things, how we educate and inform and support people and don't medicalised things that are actually normal experiences. And again, as a GP, a huge part of what I do in terms of the mental health side of things is actually helping people deal with what are essentially normal human experiences, but they are feeling and experiencing abnormal ways. Sometimes that is fundamentally due to a genuine mental health disorder, but a lot of the time it is, for whatever reason, their inability to cope with it because they either haven't been equipped for that, prepared for that, or other pressures are compounding and making them feel these things more keenly than they otherwise would. 8s There. 10s So, particularly on the sort of mental health side of it all mean ketamine prevention is just. 2s Yeah, well it's someone. Okay. Mean think there is something. Okay, let's take it back. Let's do it at the life course way, then. Um, I think there's a huge amount for our children and young people. We don't talk enough about children and young people's health and wellbeing, both their physical and the mental health. I think our education, unfortunately, because government is very siloed. Department for education, Department for Work and Pension. Part of this for health and social care are very separate from each other. They are not. There is far less cross communication across government than I had hoped or anticipated, though I wasn't the more senior I get, the more surprised I get at times these great gulfs between them. So social prescribing is obviously something that cuts across all these things. It is in every part of government there is a space for a conversation about how we can help our citizens be the best they can be, but particularly those areas. And 1s obviously the Home Office is a massive area as well. But for children and young people, education is obviously a thing we think about because what opportunities, how are we educating them for the future? Education should not should be far more than English and maths. You know, those are a fantastic foundation, but it's about an appreciation of what makes us whole as human beings, what makes us, what gives us satisfaction, what makes our heart sing, what how we can be the best people we are so recognising our individual skills, talents and the opportunities we have ahead of us, reaching, helping people reach their potential and a good education establishment will do that. But think more widely in terms of giving people the emotional and mental health skills for the future as well. So good schools will tackle issues about grief and loss and disappointment and rejection of frustration. I think a lot of these things, which perhaps we regard as the sort of the soft curriculum or the unwritten curriculum in schools, and we lost when our young people weren't interacting with each other, when they weren't interacting with other children, when they were stuck at home, they only had the interactions of their families, which they had. They always have those anyway because of weekends and evenings and holidays. But school provides that, all those socialisation things. So not that everybody has to be a great joiner in and has to love. I'm not expecting everybody to be the noisy, bouncy extrovert that I know I am, but actually recognising how to play well with others, how to take rejection, how to win well, you know, all those coping things. 1s And Thanksgiving yet for so for now, for me, it's giving young people ready access the resources. There are some amazing books and written resources out there for children and young people about coping with all these things. And, you know, I, I'd like to think that our teachers know about these, but I'm pretty confident. Awful lot of them don't know what's out there. You know, often actually, primary school teachers are better understanding of all these things. But once you get into discipline specific in secondary care, there's less of a general understanding of this stuff. And that's a huge generalization. There are phenomenal teachers who get a lot of this stuff, but some don't. And I think it's recognizing that when we educate, we educate for life, not just for one subject, not just for a job. In terms of adults, it's about permitting society, permitting conversations about these difficult things, giving people spaces and so many areas of society. Now, it's not acceptable to talk about this stuff. There aren't safe spaces, so how do we better promote to people what's out there? And I'm not advocating that everybody should have a touchy feely, you know, sort of overtly therapeutic relationship with others. That's not I'm not wanting to medicalized these things. I'm actually wanting people to know that there is somewhere appropriate to go. You know, we used to call it having mates where you could just download, whereas we I perceive an awful lot of what we have now, particularly for people provided them guess a bit younger than me, but sort of people from 40 downwards. 50 towers who are under huge pressure to portray to the outside world a perfect life that they live this wonderful, perfect existence. The only thing you show to others is how amazing everything is, how beautiful everything is, how perfect relationships are and how we. 1s Really celebrate that it's okay to be suboptimal. You know that 1s imperfection is cool. Imperfection is normal. Um, and I think those are things that lots of people can do. And there's a lot of people that influencers can do. And if we see kickbacks and swings to this all the time, I'd like to amplify that. And then I think for old people 1s and again, talking, I think it's a recognition of what we need as individuals. And certainly it's creating spaces for people to be able to talk about what they their hopes and fears. Because of all the generations that were stiff upper lip. It is people who are slightly older. What I haven't spoken to you about is the conventional health promotion or health prevention messages, which are clearly there's the massive lifestyle stuff about smoking, drinking, you know, physical activity, cancer prevention, vaccinations to prevent against cancers. You know, there is tons of stuff there that I'm kind of taking that as read. People listening to this will will know about that stuff. 37s Purpose. 10s So interestingly, with older people is an awful lot about loneliness, as you might expect and have to say, I got very interested in understanding the difference between loneliness and social isolation. So social isolation is a very measurable thing. You can count the number of contacts a person has a day. So social isolation is quantitative, measurable. And it's not always a bad thing. Somebody being socially isolated, they may well be so stressed because they're quite happy to be socially isolated. Thank you very much. Whereas loneliness is the subjective experience of insufficient social interaction or social interaction that is of insufficient quality, that is not fulfilling. So you can be lonely in a crowded room. Yeah. If you don't feel part or you don't feel that you belong. So understanding the difference between social isolation and loneliness is really important. And one thing that we did in the pandemic, a lot of these social prescribing link workers reached out to isolated people in the community. They picked up the phone, I spoke to him and. 1s There was a really wide range of responses. People were always courteous and polite and grateful for the contact. But there were some who said, no, no, I'm absolutely fine. Yes, I am here on my own and the only people see, I'd have the other phone call with a couple of people a week and I get my food delivered and that's that's fine. And there were others who subjectively would have quite a lot of contacts, actually were devastated by it because of the lack of quality of it. So 1s I think that's helping to understand those differences, not assuming everybody needs the same thing. And. 1s But also there is so much out there. The third sector is massive in terms of the opportunities, so there is something about just making people aware of what's out there and and helping people take the first steps, because it is hard to step into a room full of complete strangers. I mean, just joining a knit amateur group, there can be nothing more cliquey than a bunch of women who are single get together to natter every week with their knitting. And if you walk into that and you don't quite fit the clique and they're not expecting new people to join, that can be just as ostracizing as to walk into a pub in a strange town when everyone goes quiet as all the heck of you. And yet, with a tiny bit of preparation, there's a new lady moved in. She's a few doors down. She doesn't know anybody. I was thinking of inviting her to the group next week. Fantastic. She'd be welcomed with open arms for men. This is certainly for older men. One of the hardest groups in terms of getting them to acknowledge their needs and wants, but also some really good stuff. There's walking football groups, there's men in sheds groups. There are brilliant allotment type stuff. There are there are groups set up specifically for quiet men who don't want to chat, but just need a bit of social contact, and whether that is picking up some new woodworking skills or something like that. But having the social company and safe spaces. Anyway, I could go on about this for ages and you can tell I'm really passionate about it. And what I don't have for you is a prescription of how it should be done, and it needs to be organic. The resources are there if you go looking for them, but you need enough enthusiasts to lead and to seek and to connect others. 16s Hmm. 7s So if you're thinking. Yeah. So okay, so there's the various routes really. So first of all, if you I mean most GP practices in England now have access to a social prescribing link work. So you can just phone up the surgeons say, look, do you have anything like this. My aunt arranged a patient with you or I'm a patient with you and I've heard about this thing. Is there access to this locally? And if not there, then often local government, local councils will have similar schemes available. A lot of them. And I'm joined together and combined quite appropriately. The idea is that, you know, we're getting close to the point where everybody in the country should be having access to some sort, some of this via primary care. And it doesn't have to be that refers you in most places. The link workers will take referrals through the reception team or self referrals and so on. Without nurses in the practice. And in terms of what they mean, people want to know about the movement more than obviously, the National Academy for Social Prescribing website or Social Prescribing academy.org UK. And we've got loads of stuff there. There are pages on the evidence around social prescribing. We've touched on that, just a little on it, but we haven't gone into that much. There are pages of work that's being done. You know, there are there's a fantastic collaboration of, I think it's ten universities in the UK that are collaborating to generate both evidence summaries about what is known but that are bidding for an undertaking, recognised evidence, proper research and publishing in this space because there has been a lack of hard evidence out there. But we're bringing it together and then the other pages of that, but also ways of getting involved. And if you're interested in becoming a social prescribing link worker, 1s there is an organisation called the National Association of Link Workers and Al W, and they they've got a good website and they are the sort of like the professional body for link workers and an NHS England society, NHS England link workers 1s England social prescribing. There's quite a good site there with some sort of definitions and how things are done. Most appointments of people into NHS link workers are done at a local sort of practice or primary care network level, so you can look out for adverts and. 1s And beyond that. I mean, just just Google social prescribing and there's some really interesting stuff out. There's a lot of organizations in this space. And the academy, the National Academy is one of the one is the largest. It's sort of unique in terms of what it does and its funding. But there are loads of local organizations and some amazing things out there. 17s Yeah. So no really really good question. So a lot of the things that are prescribed of course are recommended to individuals are free. They, you know, going out to community resources that already exist or whether they're very modest contribution. And there are various initiatives. So with gyms that we've done some fantastic work getting a load of gyms to donate free hours, I think we got a million free hours of gym time donated to link workers, and they could give out free vouchers to people to try going to gyms. And quite a lot of gyms have schemes for people with financial hardship, have an awful lot of council owned gyms and swimming pools, have free access to those who needed so long as you can via either a link worker or perhaps a health coach. I should explain that when NHS England introduced the social prescribing link workers, it was part of a triad, new roles that were introduced. So we had the link workers, we had health coaches and we had care navigators, and those three roles were meant to overlap. So care navigators, helping people understand the boundaries between systems, how it links up, how to navigate the system, particularly for those with cognitive impairment, those who are older or more frail, or those with complex serious disease. Health coaches, as it says on the tin, coaching people about sort of health, but particularly about the lifestyle measures. So helping people to get more active and then obviously link workers as we've described so and that tried you can kind of see how those all fit together on the fringes of what we were always doing, you know good a good practice receptionist was always a care navigator anyway, did a bit of social prescribing and did a bit of certainly signposting about the health coaching staff practice. Nurses have always done a lot of health coaching, but you can see why each of these has taken work away from other people in the system and allowed people to concentrate on doing it well. 1s Sorry, that was an aside, but just to explain the landscape. 16s So certainly the National Academy for Social Prescribing websites a really good place to start. I've got a biography at the University of Birmingham, which sort of summarizes a whole heap of the crazy things that I did, because I've got involved in all sorts of other things, too artificial intelligence and genomics, which are kind of the other end of the personalisation spectrum from what we've been talking about today. But yeah, don't be afraid to reach out and good luck with this space. It's exciting. It has huge potential, but it is not a panacea. The NHS is seriously underfunded. We have insufficient workforce for the work we're trying to achieve. Those cannot be fixed by more social prescribing link workers. Those things need to be addressed a political way. So we'll keep fighting the fight as best I can for the big picture too. But thanks ever so much for your time and your lovely to meet you. 3s Because.