Social enterprise and wellbeing in communities

Scotland’s public health reform starts from a simple observation: most of what makes people healthy or ill happens outside the NHS. The six public health priorities agreed by the Scottish Government and COSLA in June 2018 include good mental wellbeing and healthy, safe places and communities. A new national public health body is being set up to lead the work, and the reform papers speak of “whole system” working, in which councils, health boards, the voluntary sector and communities pull in the same direction.

That leaves a practical question. If health is made in homes and neighbourhoods, who in those neighbourhoods is doing the work? A good part of the answer is small community enterprises that already run exercise classes, cafés, workshops and sports centres, often for people that statutory services struggle to reach.

Social prescribing

The clearest route in is social prescribing. A GP who sees a patient whose underlying problems are loneliness, debt or inactivity can refer them to a community link worker, who connects them with local groups and services. The approach grew from a pilot with GP practices in deprived parts of Glasgow that began in 2014, and in 2016 the Scottish Government committed to funding at least 250 community link workers by 2021. A link worker can only send people to what exists locally, and in many places what exists is run by social enterprises and charities.

What it looks like

In Oban, Lorn and Oban Healthy Options works with local GPs and health staff on exercise referral. People living with a long-term condition, or at risk of one, get a supervised programme and then move on to group classes and walks. They can also refer themselves without going through a doctor.

In Edinburgh’s Old Town, the Grassmarket Community Project grew from a partnership between Greyfriars Kirk and the Grassmarket Mission. It works with people affected by homelessness, poor mental health and disability, and runs several trading businesses under one roof, including a café, a tartan weaving enterprise and a woodwork shop. The businesses bring in income and give the people who come there work, training and a reason to be somewhere each day.

In Kilmarnock, Centrestage uses music, drama and food to bring people together. Its community meals work trains local people to cook and serve using surplus food, so that a meal becomes a reason to turn up rather than a handout.

In Aberdeen, Transition Extreme runs a climbing and skateboarding centre on the beachfront as a charity and social enterprise. Alongside its paying customers it runs a programme for teenagers who are not getting on in mainstream school, using sport to build confidence and gain qualifications.

Why it works, and where it strains

What these organisations share is that people come for an activity and stay for the company. That matters because wellbeing depends heavily on having somewhere to go and people who notice when you are missing. Because they trade, they can keep going between grants, and because they are local, they are often trusted in a way a clinic is not.

The strain is money. A referral scheme can send more people to a walking group or a gym session without sending any funding with them, and a small enterprise that takes NHS referrals ends up doing health work on a community budget. Evidence is the other gap. Outcomes such as less isolation are real but hard to measure, and commissioners tend to fund what they can count. If whole system working is to mean more than a phrase, it will need grants and contracts that pay community providers for the extra work referrals bring, along with simple ways of recording what changes for the people who take part.

Since then: the new national body, Public Health Scotland, began work on 1 April 2020.