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We are fast approaching the 10-year anniversary of then health secretary Alan Johnson's call for participatory arts to be part of the mainstream in health and social care.
A decade after this speech, while the evidence base for the impact of arts on health and wellbeing continues to expand, provision across the country remains patchy.
Over the past six months I’ve been working with people across the worlds of arts and health to help them co-produce a plan for a new national strategic centre to support the advance of arts and health. This was a key recommendation of the report Creative Health: the arts for health and wellbeing which is an encyclopaedic summary of arts and health activity across the United Kingdom gathered through a two-year inquiry by the All Party Parliamentary Group on Arts, Health and Wellbeing (APPGAHW). The report outlines the many and various ways that the evidence for arts and health interventions is generated, from randomised control trials assessing the effectiveness of arts therapies to assessing the social return on investment for arts on prescription.
After many interviews, two workshops and focus groups in Gateshead and Shrewsbury, a clear aim for the centre was articulated as achieving 'culture change' so that the case for arts and health is accepted across the system, by providers and commissioners of health and social care – not least so that the two sectors are able to better communicate with each other.
One way of effecting change is to work with national policy levers – this is what happened when sport was championed from within NHS England under the Everybody Active Every Day framework. Another is to work at a local level – social prescribing is currently the obvious lever for arts and health but there is a challenge not only in promoting the uptake of social prescribing in general, but of arts on prescription in particular. As always there is significant variation in provision across the country; some people are way ahead of the pack while others don't see the need to engage at all. Gloucestershire CCG has incorporated arts on prescription throughout its clinical pathways, for example, using drama to support teenagers with type 1 diabetes to manage their condition. But it is rare for it to move out of general practice, and provision even there is far from universal. Social prescribing is dependent on there being capacity to provide such services in the local area – the opportunity to be involved in arts and cultural activities is not evenly distributed throughout England.
This is one of the key challenges at a wider health system level where top-down direction and targets are being replaced by new models of care, and so developing capacity in a local area is as important as determining policy from the centre. The decision by the APPGAHW to avoid handing down a solution from on high and instead to approach the design of the national strategic centre for arts through co-production based on insight from people in the field mirrors this way of working.
There are some local innovators in arts and health, for example, Creative Inspiration Shropshire, a community interest company that describes itself as a creative wellbeing network. The type of structure used by this service – a flexible network of arts and health champions which 'meshes' with the existing local hierarchy of local government, clinical commissioning groups and other health and social care bodies, provides a possible model for a national strategic centre for arts and health. This approach of using a network of champions supports the theory that the more people involved in ‘strategic game change’ the faster change will be. This approach also chimes with recommendations 3, 4 and 6 of the Creative Health report which recommended that the proposed centre for arts and health will need to work through a network of champions and by influencing partnerships at a national and regional level. As Alan Johnson said almost a decade ago, arts in health is ‘not some kind of eccentric add on’. Continuing to develop local champions in arts and in cultural wellbeing in its widest sense will be crucial to the success of arts on prescription, and therefore for social prescribing more broadly.