SNP centralisation halting progress on public health issues

Advocates of social prescribing, where patients are instead directed to community supports, say in many cases treatment fails because it hasn't solved the root causes of the distress.

Around 20-30% of health service costs are said to be wasted on so-called 'failure demand'.

Experts say community-led health groups could make inroads into persistent health challenges including obesity and drug addiction if they were adequately funded.

Out of 452 referrals to one Scotland-wide project, which offers counselling and money advice,  48% of participants reported visiting their GP less often, 52% had fewer trips to A&E and 75% had less hospital appointments overall.

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Of the 154 doctors who referred patients to group, 60% said they saw an improvement in health while patients said they were more confident about managing their ailments.

"They reckon that for £1 spent on an community-led health organisation it saves the NHS £10," says John Cassidy, Chairman of Scottish Communities for Health and Wellbeing.

"It mounts up incredibly fast, it's huge money. 

"Nobody talks much about this in Scotland but failure demand is the biggest cost to the NHS. If a decision is not made correctly with an individual, they get passed to expert to expert in the NHS and they end up not being any better off. 

"It's what happens and it's a major, major cost to the NHS. 

"Everyone can get into mental health difficulties, everyone can get into using substances wrong.

"A key part of social prescribing is that an individual will actually sit with someone and get to know them and find out all the different things that are making life not very good for that person.

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He added: "We've got about six epidemics going on including obesity and they are not going to be solved in a real way unless we manage to spread this community-led approach across Scotland so it's available to all GPs."

He said he had recently been asked for advice by government minister on how to spend a new £16million fund for families and young people that has not yet been announced.

"It's the completely wrong way to do it," said Mr Cassidy.  If you take £16million and spread it across a whole country, it just wouldn't do the deed and it's for one year."

Glasgow Caledonian University is carrying out a study looking at the health benefits of community-led projects.

Mr Cassidy, who is a former director of education at South Lanarkshire Council, says too much government money is directed to health improvement campaigns and pilot projects when "we know it all already."

"There are two things they like to do, which give them headlines and one is announcing big sums of money. You have to be realistic about what that big sum of money can do.

"The history is and the audit commission have proved this - it doesn't go very far.

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"The other thing they like to do is run a pilot project. We've learned it all, we know it.

"I don't want to make a political point here but we do seem to have a very centralising government where they like to keep control of things centrally and that's a big issue.

"They seem to think that investing in communities, despite the rhetoric, is too big a risk. It needs a long term commitment. You wouldn't cut (funding) off to a hospital for a year."

The Scottish Council for Voluntary Organisations (SCVO) criticised the government's flagship economic plan, which was unveiled this week, saying it, "largely ignored the sector" and was too business focussed. 

Clare Cook, is regional manager of the SPRING project, which offers exercise and health advice, counselling, energy and money advice, arts and crafts and volunteering opportunities.,

There are eight organisations across Scotland and project leaders say they can't keep up with demand.

A third of people are referred because of mental health issues, while poor physical health accounts for just over a fifth.

She says it differs from the link workers that were put into 'Deep End' GP practices, serving Glasgow's most deprived areas because the social prescribers are based in the community and not based in GP surgeries.

"A lot of people are terrified to go to their GP," she says.

"As we know, someone with depression and anxiety isn't going to pick up the phone but they might be more comfortable going into a community group in a church hall."

Another community enterprise, GRACE, which operates in East Dunbartonshire, offers peer-led supports for people who have experienced ill health, loneliness and isolation or homelessness and drug addiction.

A spokeswoman for the project said there was "many instances" where participants would have been hospitalised if they had not been members.

Dr Andrew Buist, chair of the BMA’s Scottish GP Committee, said social prescribing was a "broadly positive" initiative and particularly helpful in addressing isolation, low mood, and other mental health issues.

However, he added: "Currently it is not completely reliable and for it to work we need to ensure we have the facilities and groups within the community to support it, and ensure they are well publicised and easy for patients to engage with.

"We must also be mindful of the risk of increasing health inequalities if services are not appropriate to sections of communities."

A Scottish Government spokeswoman said: “We are committed to addressing the underlying causes of health inequalities – we are committed to ending poverty, increasing equitable access to fair employment and improving our physical and social environments.

"Alongside action across government to improve the determinants of health, we are adopting a place-based approach to local health improvement.

"We will target actions in areas and communities most in need to ensure equity in our approach, thus avoid widening inequalities further.

“We will focus on cultivating community-led health improvement activity as we know how vital these organisations are in addressing health inequalities.

"We are looking at how we can better integrate community-led health organisations within local health and social care delivery.

"This will be achieved by working more effectively in partnership across government and with our local partners across all sectors. Community partners will shape what we are doing and steer long-term solutions and we intend to set out key priorities and approach in the coming months.”