I would like to welcome Professor Marcello Bertotti Marcello to the guest blog spot on Connected Communities. I have worked with Marcello now for a number of years, connecting initially through the Social Prescribing Network of which he is a steering group member.

Marcello is a key figure in social prescribing, known for his influential research and dedication to improving health and wellbeing in communities. He has helped shape national and international approaches, combining rigorous evaluation with a collaborative, asset-based mindset. Marcello's curiosity, and commitment to connecting people and indeed countries make him a much valued and inspiring member of the social prescribing community. It's always a thought provoking and enjoyable time when working with him.


Marcello is a Professor of Community Health at the Institute for Connected Communities, University of East London and a leader in social prescribing research and evaluation. He has worked across multiple disciplines including Economics and Politics, Human Geography and public health when he joined the University of East London. The journey through these different disciplines is centred upon Marcello's interest in the social, economic and health regeneration of urban areas and vulnerable people living in them.

Marcello is particularly interested in both health outcome and economic evaluation. He has made an important contribution to the development of social prescribing evidence in the UK by conducting a considerable number of evaluations and reviews about the effectiveness and cost-effectiveness of social prescribing over the past decade. He led one of the first evaluations of social prescribing in the UK for adults (Hackney in 2015) as well as children and young people (Luton, Brighton and Sheffield in 2017). Marcello is also a co-founder of both the social prescribing network (SPN) and the social prescribing youth network (SPYN).

Overall, his research has shown that social prescribing makes an important contribution to health and wellbeing for both adults and young people particularly in relation to mental health with link workers playing a crucial role in it. However, link workers often experience a range of difficulties in supporting people effectively, some of which could be tackled by improving policy design.

Marcello has a keen interest in the development of different models of social prescribing which can be adapted to different locations and countries, not just in the UK but internationally. For Springer, he has edited the first book in the world on research, policy and practice of social prescribing in seven countries (England, Wales, Republic of Ireland, Portugal, Germany, Canada and Singapore, and, just completed a social prescribing evaluation of social prescribing for young people Not in Employment, Education or Training in Italy and Portugal. He is now working on a project led by a UEL colleague (Dr Ainul Hanafiah) and the WHO social prescribing collaborating centre in Singapore to adapt social prescribing to South-East Asian countries (Cambodia, Indonesia, Malaysia). 

Prescribing Connection: How Social Prescribing is Transforming Health, Communities and the NHS

by Marcello Bertotti 

Prevention, waste and wellbeing: what social prescribing can (and can't yet) do for the NHS 

The NHS needs to help people to stay healthy, not just to treat them when they are ill. I promise I will not stray into an extended theoretical discussion here, but the concept of salutogenesis (Antonovsky, 1996) provides a useful underpinning for understanding why social prescribing is so important. Salutogenesis starts from the idea that humans are inherently vulnerable, in other words, they tend to become ill. As a result, health and wellbeing need to be proactively sought, rather than assuming that individuals are healthy until illness occurs.

While it is crucial that people are treated when they fall ill, as in the current healthcare system (pathogenesis), more time and resources need to be devoted to prevention, management, and, more broadly, to minimising the impact of an economic and social system that generates health inequalities. This is particularly important given the rising prevalence of co-morbidities and long-term conditions associated with an ageing population and, as many have argued (e.g. Wilkinson and Pickett), an unequal distribution of wealth that affects wellbeing in multiple ways.

The NHS already accepts the logic of prevention and invests in it, but it does not currently pursue it far enough. The Health Foundation has argued that the public health grant, which drives much spending on prevention, has been cut by 28% per person in real terms over the last ten years (2015–2025) and now represents only around 2.2% of the NHS England budget. This balance is unlikely to change substantially in the short term, as COVID-19 and previous under-investment have left the NHS requiring ever-increasing levels of funding simply to maintain core services.

At the same time, some published estimates suggest that around 20% of healthcare resources in the English NHS are wasted (Jani and Gray, 2024). The current government appears to be attempting to address this, at least in part, through technological change. Could social prescribing also form part of the solution to waste in the NHS, given that it may prevent some health problems and help manage others at a cost that is likely to be substantially lower than that of primary and secondary care? Might social prescribing delivered in hospital settings also help reduce readmissions to secondary care, where costs are even higher?

The current evidence base for the latter remains limited, but there is good reasons to believe that the opportunities are substantial. For example, cost-utility analysis of social prescribing housing support for homeless people following hospital discharge showed QALY gains over standard care (Tinelli et al 2022). Anecdotal examples show that social prescribing could help with earlier hospital discharge to a suitable accommodation, saving the NHS considerable resources and freeing up hospital bed space. 

Evidence of implementation and impact 

The evidence base for social prescribing is steadily improving. While earlier systematic reviews cautioned against limitations in rigour—such as small sample sizes, limited longitudinal follow-up, and the absence of control groups—substantial progress has been made over the past two to three years. For example, researchers at University College London (Bu and colleagues) have published three major studies examining the implementation (two studies) and impact (one study) of social prescribing in England, drawing on extremely large datasets and analysing changes over time. One study examined mental wellbeing among 19,627 individuals over six months and found a meaningful average improvement in mental wellbeing, alongside improvements in personal wellbeing indicators such as happiness and life satisfaction.

In addition, a repeated cross-sectional survey of over four million users in England conducted by Wilding and colleagues (2025) showed that increased provision of link workers was associated with greater confidence in managing long-term conditions and improved perceived support from local services. The same research team also conducted a quasi-experimental study involving 8,232 patients, which demonstrated reductions in diabetes-related outcomes and non-elective inpatient care, particularly among older, non-White individuals with multiple co-morbidities (2021; 2023).

It is therefore now reasonable to argue that social prescribing can improve mental wellbeing, life satisfaction, and self-management of long-term conditions, while also potentially reducing health service use. Nevertheless, considerable work remains to improve the effectiveness and efficiency of social prescribing interventions. 

Some remaining challenges 

Despite this growing body of evidence, several important issues require further attention. First, Bu et al. (2025) showed that although targeting of people living in the most deprived areas has improved over time, inequities in access persist. Similarly, Wilding et al. (2024) concluded that link worker provision has not been sufficiently targeted towards areas of greatest need.

Second, Bu et al. (2024) reported that only 38.3% of approximately 160,000 referrals resulted in an onward intervention—roughly two out of five people. This warrants further investigation. It may be that some individuals benefit sufficiently from support provided by link workers alone, without referral to community activities, but other explanations are also plausible.

Third, there is substantial evidence demonstrating the positive effects of engagement with nature, physical activity, and the arts (e.g. work by Daisy Fancourt and Helen Chatterjee) on health and wellbeing. However, a key challenge remains: how can we encourage people who might benefit most to engage with and sustain participation in these activities? The voluntary, community and social enterprise (VCSE) sector has often been particularly successful in engaging individuals due to its deep roots in local communities, but further learning may need to be shared across settings, regions and countries. 

About Marcello:

Part of the world I live: South London (Croydon)

Occupation: Professor in Community Health

What makes You well? Football, playing guitar, walking in the countryside, my family (most times!), parmesan cheese and chess not necessarily in this order!

Why is social prescribing important? Lots of reasons: good for people's health, grows communities by linking people and supporting social networks, it is good for the NHS too in terms of cost savings, and can be preventive too which helps to avoid further health problems down the line.

Your favourite nature based space? Bansted Wood in Croydon and Dartmoor national park are fantastic places, but the Dolomites in Italy is where my heart lies.

Your favourite music? That's an almost impossible question to answer as this depends on my mood. I love both English/American and Italian music for different reasons. I like old music particularly Bob Dylan, Simon and Garfunkel and the italian singer-songwriter Francesco Guccini but it is difficult to choose. Lately my daughter introduced me to more 'recent' bands including Arctic Monkeys, the Killers, Bastille which have grown to like a lot.

Your favourite pastime? Walking

If you had one wish for social prescribing what would it be? More funding and training for link workers (perhaps these are two wishes!)

What are your leadership tips for others who want to set up social prescribing projects? I am not really an expert in setting these up as I am a researcher and evaluator. However, I would say that asset mapping is the starting point, partnership building, and choosing the right link workers with adequate skills and attitudes.

Which one person has most influenced you and why? Muhammad Yunus who won a Nobel Prize in 2006 for the creation of micro-credit and the Grameen Bank. It has taught me that people have got a lot of skills and can succeed, given the chance and also that women are more reliable than men, at least in repaying loans!