A breath of love...the power of social prescribing

21 January 2021

The power and healing qualities of breath have been brought to the fore during the coronavirus pandemic as people have literally struggled to breathe.

The connection between the health crisis we are facing and opera may not be immediately apparent. However, through social prescribing activities such as the English National Opera’s - ENO Breathe programme, COVID-19 sufferers are being supported through their recovery. Opera is a prescription.

The importance of breath technique in performing opera and its associated healing power has long been understood. In Mozart’s opera Cosi Fan Tutte, Ferrando sings of: “Un’aura amorosa, del nostro tesoro, un dolce ristoro, al cor porgera” (A breath of love from our loved ones, will offer our hearts sweet relief).

Supporting patients with breathing techniques by referral to non-clinical services is just one of many health services being offered to patients through a pathway called social prescribing.

What is social prescribing?

Sometimes known as community referral, social prescribing is usually carried out by primary care professionals such as GPs or practice nurses. It is a way of helping patients improve their health and wellbeing by connecting them with non-clinical services to address health, social, emotional or practical needs. Examples range from supporting individuals to engage with classes such as those teaching breathing techniques, referrals to healthy eating groups, exercise classes or volunteering opportunities.

Although the evidence on the impact of social prescribing is mixed, a number of studies, such as the evaluation report from the Rotherham Social Prescribing Pilot, found significant outcomes for service users and the NHS including:

  • A reduction by as much as 21% of inpatient admissions and outpatient appointments.
  • An analysis of wellbeing data showing that, after three to four months, 83% of patients had experienced positive change in at least one outcome area.
  • An estimated total NHS cost reduction by the end of the two-year pilot of £552,000: a return on investment of 50 pence for each pound invested.

NHS England has embraced the concept of social prescribing and it forms a key policy area within the Long Term Plan in developing systems of personalised care:

Within five years over 2.5 million more people will benefit from ‘social prescribing’, a personal health budget, and new support for managing their own health in partnership with patients' groups and the voluntary sector”.

Why is social prescribing so important for boards right now?

As a society we have faced growing healthcare needs for some time, with conditions such as mental health, loneliness, isolation, obesity and the complex challenges of an ageing population all putting additional strain on NHS services. In a poll of more than 1,000 GPs, conducted by the Campaign to End Loneliness, over 75% stated they were seeing between one and five people a day, mainly because they were lonely.

The pandemic has inevitably heightened many of these issues with 24% of Britons saying they feel more lonely than usual. A recent report by the British Medical Association raises concern about the anticipated increase in demand for mental health services due to the pandemic.

Social prescribing could offer a beneficial, cost-effective way to address many of these health issues through community-based activities, reducing the burden on primary and secondary care services and providing positive health and wellbeing outcomes.

Social prescribing fits into systems of place based care

Social prescribing works through effective collaboration, between partners such as health and community-based organisations focused on individual patient outcomes and need. As organisations move increasingly towards systems of placed-based care with partner collaboration, community involvement and the co-design of services at their centre, social prescribing as a method to improve population health outcomes is a good fit.

Resourcing of social prescribing activities and monitoring outcomes should also be facilitated through a systems and partnership approach focused on measuring outcomes, reducing health inequalities and improving wider population health.

Prescribing opera

In August 2020, the government allocated £5 million to National Academy for Social Prescribing (NASP), some of which went to a programme called ENO Breathe, devised by Imperial College Healthcare NHS Trust and the English National Opera.

The smaller, but equally enterprising Barefoot Opera company, has embraced the power of social prescribing through its classes run in partnership with Arts on Prescription. Singing is free, cheap to run, and has fantastic benefits ranging from health and mood boosting benefits, to allowing participants to communicate more clearly and become proactively enabled in their communities. The benefits to health and wellbeing from those that took part are clear:

“This chance of being taught how to breathe and open up has been a minor miracle in this horrible situation. Just the breathing alone has helped...today I opened my throat and belly and sang. I can’t tell you how happy it has made me. Thank you for what you are kindly doing to keep people singing.”


  • Social prescribing offers real opportunity for improving health outcomes while reducing the burden on secondary and primary care services.
  • Social prescribing fits neatly into structures based on place-based care and in meeting population health outcomes.
  • By identifying, supporting and co-creating services in partnership with the community and third sector organisations that deliver social prescribing activities, boards could see real benefits in managing and monitoring population health and wellbeing outcomes.

If you have any questions or comments about this briefing, please call us on 07732 681120 or email advice@good-governance.org.uk

Prepared by GGI Development and Research LLP for the Good Governance Institute.

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