On Wednesday 19th June, Bishop Sarah delivered the keynote speech at the International Social Prescribing Conference at the University of Westminster, discussing the involvement of faith groups in social prescribing.

Good morning, it is my pleasure to be speaking at this, the International Social Prescribing Conference today.

I have spent my adult life serving in two of Britain’s most prominent institutions; the National Health Service and the Church of England, as Chief Nursing Officer to the government and now as Bishop of London. And whilst the two worlds have always been linked, I speak to you today from the intersection of both. There are many similarities between nursing and being a priest- not least that I find myself in strange uniforms! But they are both about people, compassion and service.

Their similarities have also become clearer with the realisation of the social determinants as key to our health.

In western cultures there have been many influences in defining health and healing, but medicine has increasingly dominated.  This domination arose as medicine developed a distinct body of knowledge and a profession which controlled that knowledge and its application. Western medicine has defined health as the absence of disease and therefore for medicine, illness is more often  concerned about the deviation from physical norms and is measured in terms of biology, chemistry and physics.

The World Health Organisation defines health as a ‘state of complete physical, mental and social well-being and not merely the absence of disease and infirmity’.[1]  This approach begins to move away from a model of health which is only focused on one facet of an individual, giving recognition not just to the individual but also the community. Community focuses on wellbeing and not just the alleviation of physical symptoms, and seeks to be to preventative and not just curative.[2]  It recognises that people may have a sense of wellbeing despite major illness[3] and takes seriously the holistic, interpersonal and social nature of health. Of course, missing from this definition is an understanding of what it means to be human and the importance of spiritual health. John Swinton writes that ‘Spirituality is about a response to the life force that under-girds, motivates and vitalizes human existence’.[4] There is a lack of understanding of the importance of faith to those who have one, and of spiritual health to all of us. Spiritual health, taken alongside the physical, mental, emotional and social is a key component of the health of the whole person.

We are all aware of the persistent and growing health inequalities that mark the worst health outcome of the modern age. We are aware of the often-quoted statistic of 19 years average difference in healthy life expectancy between the most and the least deprived areas of our nation. We are aware of the exposing and entrenching effect that the pandemic has had on those health inequalities, and the stark reality that unequal health threatens the health of the whole. We are aware of the complex causes of those inequalities, and the need to look beyond the clinical factors – as important as they are – to address them. These trends are so well known now that it would be easy to become numb to them.

But I feel heavily the words in the Old Testament that describe the hurt that God feels when care for people is not taken seriously: “They have treated the wound of my people carelessly, saying ‘Peace, peace’, when there is no peace”[5]. I have seen the impact of these inequalities in both worlds, and the words of Walter Bruggeman ring true, that “the hurt is to be taken seriously, that the hurt is not to be accepted as normal and natural but is an abnormal and unacceptable condition for humanness”[6]. It is my faith that compels me to work to reduce these inequalities, and many others of different faiths or no faiths may have similar or different motivations.

I expect we are all here this morning because we know the unique and important opportunity that social prescribing offers to improve people’s holistic health and reduce inequalities.

I am here this morning to encourage you see that if we are going to make a serious and sustained effort to reduce health inequalities, in social prescribing and beyond, then faith groups must be involved.

British society is made up of people from a range of faiths. More than 60% of people in England and Wales (71% in London) identify as religious– most are Christian, Muslim, Hindu, Sikh, Jewish or Buddhist. These groups encompass a genuine cross section of society: younger, older, economically well off or worse off, LGBTQ+, and those who have historic roots in specific geographies such as Jewish communities in Stamford Hill or Bangladeshi communities in Brick Lane.

Faith groups have historically played a significant role in health provision. Some of the great healthcare institutions in our nation have origins in the Church, including St Bartholomew’s Hospital that was founded by a priest in 1123, and last year celebrated their 900^th anniversary.

It is widely known that the close friendship between William Beveridge and Archbishop William Temple, and their respective publications in 1942 of Social Insurance and Allied Services[7], and Christianity and the Social Order[8] are responsible for the welfare state we now know. The beginning of the NHS followed closely in its wake, and we are now coming to the end of the 75^th anniversary of a universal service, free at the point of use.

Much has changed since then, and faith groups are no longer at the centre of caring for the health of the nation. However, it was during the biggest health crisis of our lifetime that the importance of faith groups for our collective health began to be realised. Towards the end of the pandemic, I convened the Health Inequalities Action Group which brought together faith leaders, healthcare professionals and civil society leaders to explore how the power of faith groups can be harnessed to tackle health inequalities in London. We found three key things – 1) that faith groups are delivering some clinical services (including vaccine clinics and blood pressure checks); 2) that they are preventing ill-health by encouraging uptake of health checks and immunisations and providing community mental and health support; and, perhaps most importantly, 3) that faith groups are unique actors with the potential to promote health, often holding the deeply rooted trust of those populations that find the NHS have found ‘hard to reach’. It is often in the most deprived areas that the level of faith observance is the highest.

Here that we see the opportunity for engagement with the vital ‘PLUS’ of the Core 20 PLUS 5 in the NHS’ health inequalities strategy. It is hard to overstate the value of this relational capital to advocate for good public health.

To gather information for the report, we held townhalls at which we heard stories of amazing resourcefulness- of faith communities stepping forward to meet the needs of their people in a moment of crisis because no one else was. We heard about how one Mosque in East London had set up a temporary mortuary.

They said “There was a lack of cultural knowledge about how a burial for the Muslim community happens so we did it ourselves. We raised money so people could die with dignity.”[9] A senior leader in the Jewish Community told us about how they had designed a vaccination service that hosted separate sessions for men and women with the Jewish Hatzola ambulance service.[10] We heard people’s stories of health care they had received with a striking lack of cultural competence. This included a story of a Sikh man in Southall who had had a stroke and was unable to speak, who had his moustache and beard cut without obtaining his permission or seeking the consent of his family. This was a deeply offensive act, and after investigation it was found there was no medical reason for it.[11] We heard stories of distrust of the health service, and a lack of understanding from statutory bodies of the provision for their communities that faith groups had held for generations. One participant who was a consultant physician described his experience with the Muslim population he served, he said “My experience with the health services…people were not scared, they were hesitant that they were going to get anything out of the health services, because they’ve consistently not got anything out of them.”[12] These stories provided invaluable insight into the complexity of the relationships between faith communities and the health service during that time.

At the height of the virus, the Bangladeshi population had a death rate that was around five times higher than the White British population. The Pakistani population was around three times higher, and the Black African population twice as high. In the years that will be spent evaluating our response to the pandemic, I hope that these statistics showing the higher death rate for almost all ethnic minority groups than the White British population will continue to be starkly sobering.[13]

There is more to be done if we are to work towards building healthy, resilient and interconnected communities, and to reduce inequalities in health. But social prescribing is a unique and obvious place to begin.

In March this year, Dr Michael Dixon of the College of Medicine and I convened a roundtable to explore the role that faith groups can and do play in social prescribing, and we were fortunate enough to have some expert leaders in the social prescribing and faith worlds participate. It was a rich discussion which exposed challenges and hopes.

Firstly, it is clear that faith groups are doing social prescribing in all but name. That is- the community brokerage role of referral, and providing the services which may be prescribed. The kinds of services and support which were so important during the pandemic are, in many cases, still running. Where there is still an unmet need presented, faith groups are stepping forward. Support is often drawn on not just by communities of faith but by all faiths and none. We know that it is these kinds of community services which meet people’s practical, social, emotional and spiritual needs that has a significant impact on their health.

However, there are barriers to faith groups linking into their local social prescribing networks, and even more significant barriers to the wider partnerships that could be built to assist and resource the delivery of these services. Engagement and partnership with statutory bodies is vital if we are to realise and share in the fruit of the work that faith groups have been doing. But the administrative burden for partnership is often too high. The self-evaluation and data collection required to demonstrate the success of a project is often beyond the reach of those who run it as well. The variation that accompanies a fairly young network of Link Workers is also challenging, and Link Workers’ full case loads puts the onus for engagement on faith groups. That is difficult, because faith groups have been stepping forward to meet the needs of their people at significant personal cost in a way that they do not exist to do. Many are feeling a lack of capacity to continue to work in this way, and are experiencing burnout.

Engagement and partnership must be a priority for all of us, not a responsibility we pass on. This cannot begin in a moment of crisis where the acute need has forced it – engagement must be a long-term strategy so that relationships are well worn when those resilience-testing moments arrive.

A House of Lords Covid-19 Committee published a report in November which made important recommendations about reducing health inequalities and engagement with community and faith groups as key strategic actions which were needed to strengthen our resilience. In the Government’s response to Recommendation 2 about partnership, they said they were building trust by establishing vaccination centres in places of worship during the pandemic. Although I of course commend the setting up of vaccination clinics in these spaces, doing so is not a method of building trust, but a fruit of it. And since the pandemic, this engagement with faith groups has not been sustained. The leaders we spoke to described being ‘picked up’ when they were needed in crisis, and ‘put down’ when it was over.

The opportunity that partnership through social prescribing presents is vast. Faith communities are present in every locality. Those who belong to such communities, and those who connect with them through the many social projects which they sustain, bring with them the whole of their lives, including their questions and concerns about their own health and the wellbeing of those they love. Working with these important groups is not an opportunity we can afford to pass up. We know that during the pandemic that red tape was cut in order that faith and community groups could be involved with delivering services at pace, and we rightly herald that time as full of important lessons learnt. As we adjust post-pandemic from a short to a long term view again, we must retain those lessons, and consider now how to adapt our posture to overcome the barriers that we face to key partnerships.

There is much good work happening that is building on those lessons, and much to celebrate.

• The Church Works Commission are undertaking a piece of research with the think tank Theos to explore the practical opportunities, impact and barriers for faith group involvement in social prescribing. This is in order to share best practice case studies, and explore opportunities to promote greater connection and availability in faith based social prescribing. The online launch with the full research findings will be taking place on 30^th January 2025 at 11am, and Esther Platt from Church Works is here at the conference for people to speak to.
• We heard from the National Academy for Social Prescribing at our roundtable who have also identified the need to support the Voluntary, Community, Faith and Social Enterprise sector with planning and delivering evaluations of social prescribing, and they continue to work with stakeholders to develop good practice in evaluation. If this kind of support is accessible and widespread it will be significant for faith groups in their evaluation efforts.

The contribution of faith groups to the health of their local communities is slowly being recognised. It is my hope that the potential impact of wider strategic engagement with faith groups over the long term would also be recognised.

We have an opportunity to work towards an interconnected network of social prescribing services in which holistic health is prioritised.

We have an opportunity to build resilient communities, in which local partners are involved in ensuring the provision of culturally competent services that meet the needs of their populations.

We have an opportunity to put in the work to grow the trust between all parties, and strengthen the health of our local communities – preparing us to face future crises not with emergency introductions but with well-worn relationships and collaboration.

I hope this morning and the whole of the conference will encourage further conversations about how we can utilise social prescribing and promote partnerships with faith and community groups to reduce health inequalities. Thank you.

[1] Pilch: 24

[2] Margaret Stacey in Ham: 217

[3] Robinson, S., Kendrick, K., and Brown, A., 2003, Spirituality and the Practice of Healthcare, Palgrave Macmillan.

[4] Swinton, 2001:20

[5] Ibid. Jeremiah, 8:11.

[6] Bruggeman, W. (2001) Prophetic Imagination. Fortress Press.

[7] Beveridge, W. (1942) Social Insurance and Allied Services.

[8] Temple, W. (1942) Christianity and the Social Order.

[9] On Faith, Place and Health Report.

[10] Ibid

[11] On Faith, Place and Health: Harnessing the Power of Faith Groups to Tackle Health inequalities in London.

[12] Ibid.

[13] Updating ethnic contrasts in deaths involving the coronavirus (COVID-19), England – Office for National Statistics (ons.gov.uk)