What are the issues posed by food poverty and food bank referral for primary care providers and patients in London? Findings from an ethnographic study

Problem

Social prescribing, which enables health professionals to refer to a range of non-clinical community and third sector services, is a mechanism through which primary care providers can mitigate the effects of deprivation on patient health. Welfare reforms and austerity policy has intensified the need for these services in primary care contexts. One example of this is the well documented growth of food poverty and subsequent reported increases in primary care referrals to food banks. Despite work on the use and functioning of food banks themselves, the roles and experiences of primary and social care professionals in interacting with the food banking system remain underexplored.

Approach

Taking an ethnographic approach, this study used semi-structured and unstructured interviews, observations and video diaries to explore experiences of food poverty, referral to third sector services and the referral process itself. Twenty London-based health and social care professionals and eight food bank volunteers were interviewed. Observations were carried out at local authority food poverty working group meetings and dissemination events. A total of 14 food bank clients were also interviewed about their experiences of being referred and the impact of food poverty on their health and wellbeing. Lastly, participants were asked to make a short anonymised video diary entry about the problem of (food) poverty and how it might be addressed. All data was subject to a critical grounded theory (CGT) analysis.

Findings

While food banks and other types of community organisations were positively regarded, there were numerous difficulties in terms of both referral procedures and the wider socio-political context. Maintaining relationships between primary care and changeable local third sector landscapes is challenging. Patients who would benefit from referral to food banks are sometimes unaware of services, unwilling to ask, or reluctant to accept referral when offered. Treating those experiencing extreme hardship requires unpicking a sensitive array of entangled health, social and financial problems during a time-limited interaction. This is further complicated when patients and clients have multiple vulnerabilities and lack local social ties. Recent migrants and those experiencing homelessness are particularly disadvantaged by this model. Social prescribing can serve to increase workloads, put strain on professional interactions, take up appointment spaces, and disproportionally impact upon the delivery of services in deprived communities.

Consequences

The findings have implications for primary care and the way health and social care provision intersects with third sector community organisations. The food banking system brings a range of actors into collaboration across a diversity of sites, contexts and providers. There are no national policies to help organise and manage this emergent sector and there is a danger that as a result there will be uneven access to potentially beneficial services for transient and vulnerable groups.