Health policy papers
Early health policy papers referencing the arts come from the late 1990s. One of the key drivers in setting the precedent for the consideration of the arts within health policy was the UK Nuffield Trust for Research and Policy Studies in Health Services. In 1998, the Trust organized a conference entitled The Role of Humanities in Medicine: Beyond the Millennium. The conference reviewed the use of humanities and the arts in medicine and health in the UK and the USA. The conference led to a 12-point action plan to support the arts in health, focusing on professional education, arts in therapy and healthcare environments, and the arts in community development. A year later, the conference was repeated and the Nuffield Trust published the report Arts, Health & Wellbeing: from the Windsor I conference to a Nuffield forum for the medical humanities. (21)
In the same year, the UK Department of Health published Saving Lives: Our Healthier Nation (1999), an action plan to tackle poor health, which mentioned the role of the arts in promoting social cohesion by building strong social networks, contributing to healthy neighbourhoods.(22) And in 2000, the Health Development Agency published a landmark piece entitled Art for Health: a review of good practice in community-based arts projects and initiatives which impact on health and wellbeing.(23) The paper discussed the complexity in tackling health inequalities, and suggested that social approaches to the organization and delivery of public health could have significant potential for health improvement. This built on ideas from the mid-1990s that social capital (including civic engagement, social relationships, and social support) could impact on health outcomes. The arts were identified as one of the ways of supporting social capital and broader health, with the report self-identifying as ‘a very welcome first step in documenting the evidence on best practice in “arts for health” in England’.
Following on from this surge in activity, in 2004, the Nuffield Trust published another paper strategic for the arts sector, health sector, and policymakers: Creative arts and humanities in healthcare.(24) The paper highlighted the importance of the arts to healthcare, but noted that they do not always fit easily within the UK’s target-driven national healthcare system. So the paper demonstrated how the arts could bring new opportunities to deliver on healthcare priorities. It looked at what patients, artists and healthcare staff want from arts in health programmes and made some strategic action recommendations.
On 25 November 2010, a new opportunity for the arts was outlined in a speech by the then-UK Prime Minister David Cameron in which he committed to ‘start measuring our progress as a country, not just by how our economy is growing, but by how our lives are improving; not just by our standard of living, but by our quality of life’. This led to an increasing emphasis within the UK on measuring national wellbeing. In the 2010 paper Confident communities, brighter futures. A framework for developing wellbeing, the arts were explicitly discussed in two separate sections for their wellbeing benefits: ‘participation in the arts and creativity can enhance engagement in both individuals and communities, increase positive emotions and a sense of purpose’ and ‘actively being involved in creativity and the arts helps people to connect with a wider sense of meaning and fulfilment, which can increase wellbeing’.(25) In fact, visiting museums and galleries and engaging in the arts were both listed as national indicators relevant to promoting purpose and participation. In response to this there were a number of acts produced that aimed to support wellbeing. For example, the Well-being of Future Generations (Wales) Act of 2015 was produced by the Welsh Government.(26) It is a new law that makes public bodies including local authorities, local health boards, Arts Council of Wales, National Library of Wales, National Museum of Wales, Public Health Wales NHS Trust, and Welsh Ministers think long term and work in a sustainable way, collaborating and taking a more joined-up approach to prevent problems. As an example, the act made it a duty for public bodies, including public arts bodies, to set wellbeing objectives. In this act, wellbeing was defined as having seven goals, one of which was to create a Wales of vibrant culture that encouraged people to participate in the arts. In October 2015, Arts Council of Wales published a response to this, demonstrating how the arts could and do fulfil each of the seven wellbeing goals.(27) Government wellbeing publications have continued to discuss the arts as integral to wellbeing, such as in the June 2013 Wellbeing Policy and Analysis update.(28)
Alongside the focus on wellbeing, there has also been an increasing emphasis within the UK and more widely on mental health (for more on the distinction between the two, see Chapter 2). The UK government’s No health without mental health is a cross-government mental health outcomes strategy for people of all ages. Published in 2011, it set out plans to mainstream mental health. It included the following statement on the role of arts in mental health: ‘There are many things individuals can do to improve their own mental health; for example, drinking within safe limits, taking regular exercise and participating in meaningful activities, such as arts and sports activities and experiencing the natural environment’. (29) Also in 2011, the British Medical Association published a report entitled The psychological and social needs of patients, which discussed the positive effect of arts and humanities programmes on in-patients. (30) The report included three pages on how different art forms could enhance patient experience as well as further information on the design of hospitals. Local NHS trusts have also produced their own reports discussing what the arts can bring to hospitals and community health centres, such as the 2011-2013 strategy published for the East Midlands by Derbyshire Community Health Services, Leicester City Primary Care NHS Trust, and Lincolnshire Partnership NHS Foundation Trust: Reflecting upon the value of arts and health.(31)
In addition to specific policy papers, the UK’s National Institute for Health and Care Excellence (NICE) has also included the arts in a range of guideline papers over the past few years. For example, Community Engagement to Improve Health published in February 2008 suggests the running of community arts in health workshops as health promotion activities. Similarly, the Looked-after children and young people public health guideline from October 2010 created in partnership with the Social Care Institute for Excellence (SCIE) encourages directors of children’s services, commissioners, social care teams, schools, and public health bodies to ensure access to creative arts ‘to support and encourage overall wellbeing and self-esteem’ in young people under the age of 25 who are in care. This was reiterated in the April 2013 quality standard paper. Similarly, the NICE Pathways document ‘Mental wellbeing and independence in older people overview’ encourages the integration of the arts directly into the care pathway for older people. The guidance from 2015 suggests establishing group activities including ‘singing programmes, in particular, those involving a professionally-led community choir; [and] arts and crafts and other creative activities’ as well as other ‘activities related to hobbies and interests’. Again, this was also mentioned in the quality statement for older people in care homes in December 2013. In 2013, the clinical guidelines for Psychosis and schizophrenia in young people: prevention and management and in 2014 the clinical guidelines for Psychosis and schizophrenia in adults: prevention and management each made eight references to the arts, including ‘Consider offering arts therapies to all people with psychosis or schizophrenia, particularly for the alleviation of negative symptoms’. Arts therapies are recommended to help people develop new ways of relating to others, express themselves and accept and understanding their feelings. The arts are even labelled as ‘more efficacious psychological treatments’ than counselling or supportive psychotherapy for people with psychosis or schizophrenia. There is also a brief mention of arts therapy in the National Dementia Strategy from the Department of Health from 2009. All of these documents are available via www.nice.org.uk.
This growing acceptance of the importance of arts in health has led to the development of several new commissioning models for the arts within the
UK’s National Health Service. ‘Arts on prescription’ (sometimes known as ‘arts on referral’) is a type of social prescribing. In general, this does not aim to replace conventional therapies but is added alongside to support people in their recovery such as increasing social support networks, self-esteem, confidence, and transferrable skills. Nevertheless, reduced reliance on medication has been reported from some evaluations, although research into the effectiveness and potential cost-s avings of the scheme is still very much under way. Funding has come broadly from arts budgets as well as charitable funding, while ‘prescriptions’ for patients to access the arts have come from local authorities, clinical commissioning groups, hospital trusts, and doctors’ practices. Although the model has been running for a while, Health Education England produced a new resource in 2016 entitled Social prescribing at a glance. (32) An alternative model is cultural commissioning, by which the arts and culture are directly commissioned through the health budget (sometimes with additional external funding too). NCVO (an organization that champions the voluntary sector) provides comprehensive resources on cultural commissioning including a report on a large-scale pilot that took place across 2015-2016: www.ncvo.org.uk. Further information on commissioning models is available in Chapter 7.
Tying all of this together, the Royal Society for Public Health produced a statement paper in 2013 entitled Arts, Health and Wellbeing Beyond the Millennium: How far have we come and where do we want to go?(33) This led to the launch of a Special Interest Group in Arts, Health and Wellbeing which is helping to support research, practice, and policy development in the UK (see Chapter 4). And in January 2014, an All Party Parliamentary Group (APPG) in the UK was launched with the aim of informing a vision for political leadership in the field of arts, health, and wellbeing to support practitioners and stimulate progress. Since its conception, the APPG has held a series of roundtables bringing together cross-party politicians alongside leading arts organizations and health organizations. The group has made policy recommendations for government departments including the Department for Culture, Media and Sport, and ran a major national enquiry into the arts in health, the results of which were published in 2017. Minutes from the meetings, annual reports from the APPG and the recommendations for policy are available through the National Alliance for Arts Health and Wellbeing website: www.artshealthandwellbeing.org.uk/ APPG.