Building an NHS Fit for the Future

Building an NHS Fit for the Future – NCCH’s response to Lord Darzi’s Independent Investigation of the NHS in England

Lord Darzi has released his Independent Investigation of the State of the National Health Service in England. Commissioned by the new government upon election, the report sets out the challenges facing our healthcare system and identifies key themes which will inform a ten-year plan for health.

We believe creative health should be integral to the Government’s key mission to build an NHS fit for the future. Here we set out how creative health can help to address some of the themes raised in Lord Darzi’s report and support its recommendations.

An NHS under pressure

Lord Darzi’s report finds that the health of the nation is deteriorating. Healthy life expectancy has decreased, and more people are living with multiple long-term conditions, meaning there is increasing demand on the NHS and long waits for treatment.

Creative health can help to relieve some of this pressure, contributing to the prevention of ill health, promotion of healthy behaviours, management of long-term conditions and treatment and recovery across the life course. This includes the major conditions such as dementia, cardiovascular and respiratory disease, which affect such large numbers of people. For example, singing programmes have improved respiratory symptoms and quality of life for people with COPD and long-covid. Dance reduces the risk of cardiovascular disease, and improves strength, mobility and balance, mitigating frailty and reducing falls in older adults. Music and movement are used effectively in rehabilitation from stroke. Creative health programmes support the mental health and wellbeing of people with cancer through their treatment.

Creative health offers a holistic and person-centred approach which can improve quality of life and empower people to manage their health, reducing pressures on health and social care services and supporting people to remain in employment. Reductions in GP and acute care use have been shown when patients participate in creative health programmes, bringing savings to systems.

Addressing mental health

A rise in poor mental health is also recognised as a key challenge for the NHS, with about 1m people currently waiting for mental health services. Creative health can be applied in communities, schools, workplaces, and healthcare settings to respond to the current mental health crisis affecting an increasing number of children and young people and keeping more adults than ever out of work.

Strong evidence supports creative health as an effective non-medical approach to mental health across the life-course, reducing stress, decreasing depression, improving anxiety and supporting people with severe mental illness. Embedded in care pathways, creative health is an effective and cost-effective way to manage and recover from poor mental health. Creative activities such as art and music in inpatient settings and the co-design of treatment spaces with artists and service users have been shown to improve patient experiences and outcomes, and pathways are being established to link young people to creative health whilst they wait for services.

Challenges in social care

Whilst social care is beyond the remit of Lord Darzi’s investigation, he notes the significant challenges faced by the sector and the knock-on impact on NHS services.

Creative health has benefits that are particularly relevant for social care. It supports people with social care needs to live independently for longer and improves quality of life. Creative engagement supports mental and physical health into older age and reduces the risk of loneliness and isolation, and the associated health impacts. There is robust evidence that creativity can reduce the risk of dementia, and provide cognitive, social and psychological benefits for people living with dementia. Integrating creative health in community and residential care settings will therefore help to relieve pressures on both social care and the NHS.

Repairing the NHS

The report concludes that whilst the NHS may be in ‘critical condition,’ its vital signs remain strong. The Prime Minister, drawing on key themes identified in the report, set forward fundamental reforms to rebuild the NHS including a move from sickness to prevention and a shift towards more care in communities rather than hospitals.

A shift to prevention

In order to reduce pressure on the NHS in the long-term, we need to prioritise keeping people well. Both the report and the Prime Minister’s response acknowledge the impact of the wider determinants of health - the social, economic and environmental factors that influence people’s health and wellbeing.

Creative health plays an important role in prevention and population health. Evidence shows creative activities can reduce the risk factors for common diseases in individuals. For example, playing a musical instrument reduces cognitive decline and dementia and gardening can lower blood pressure, reducing the risk of cardiovascular disease.

Applied in places and communities, creative health initiatives improve community wellbeing, reduce inequalities and add social value. Creative health influences and interacts with the wider determinants of health to improve the conditions in which people live, grow, work and age and address the causes of ill-health. It can be applied in the early years and education, housing, employment and in the built and natural environment to support a health-creating society. Creative health can increase social capital, encourage connection and sense of belonging and promote greater civic awareness, all of which are linked to improved wellbeing.

Participation in the arts over time has a positive impact on mental health and wellbeing, particularly for people living in areas with high levels of deprivation. Community assets such as museums, galleries, libraries and community allotments often already offer health and wellbeing programmes. Equitable access to these opportunities should be ensured so that more people can benefit from these health-promoting opportunities, without reinforcing inequalities.

A shift to communities

“Too many people end up in hospital, because too little is spent in the community” - Independent Investigation of the National Health Service in England

Lord Darzi’s report finds that under investment in community services has contributed to the pressures that hospitals face. In identifying key themes for the repair of the NHS, the report recommends that care is shifted closer to home, with primary, community and mental health services working together in a multidisciplinary team, as part of a ‘neighbourhood NHS.’

We believe creative health is a vital part of this community-based multidisciplinary model. A skilled and passionate creative health workforce already operates largely in neighbourhoods and communities. People can access these services directly or through social prescribing, which has been shown to improve health outcomes and reduce demand on healthcare services. Community-based initiatives with strong local knowledge and established relationships are often best placed to meet local need.

Integrated Care Systems (ICSs) and an increased focus on multidisciplinary teams working at neighbourhood-level provides an opportunity to further integrate creative health providers and creative, cultural and community assets into health and social care systems, establishing a thriving community health ecosystem, able to meet the holistic needs of its population. Combined and local authorities also have a crucial role to play in this ecosystem. Creative health aligns with local priorities in cultural and creative industries, skills and training and economic productivity. A coherent approach, working in partnership with ICSs, will improve population health outcomes.

Re-engaging staff and re-empowering patients

Patient voice and staff engagement are considered fundamental to NHS reform. We know that creative health can be used to support the NHS workforce, and as an effective tool to amplify patient voice.

During the pandemic, hospital arts teams in NHS trusts developed creative health programmes to support staff, improving wellbeing and reducing stress and anxiety. Similar interventions continue to be offered to staff returning from long-term sick leave or experiencing symptoms of burnout. In care settings, creative activities have been shown to improve the wellbeing of staff as well as residents, with corresponding improvements in job satisfaction and staff retention. Creative health applied in health and care settings therefore not only improves patient health, but can be an important tool for workforce wellbeing, engagement and productivity.

“A strong voice for patients and local communities would promote more responsive services, whilst making it easier for the NHS to fulfil its promises to promote population health and narrow health inequalities” – Independent Investigation of the National Health Service in England

Creativity allows voices of lived experience to be heard. Creative facilitation is used to challenge stigma and discrimination and improve understanding between healthcare professionals and patient groups, particularly those underserved or excluded by services. Stories of lived experience can be shared through activities such as spoken word, photography, immersive media and theatre. Creative approaches are used to co-produce and redesign services with those who use them.

Creative health in Integrated Care Systems

The report acknowledges that Integrated Care Systems (ICSs) are still refining their relationships with providers and developing local strategies to improve the health of their populations.

Creative health providers and creative, cultural and community assets are already supporting health and wellbeing locally. Recognising the value of creative health and establishing equitable and sustainable partnerships between these providers and the health system as part of the community health ecosystem will amplify the benefits to population health.

ICSs provide an opportunity to bring together stakeholders across health, local authority, culture and VCSE sectors to provide effective creative health interventions at neighbourhood, place and system level, supported by national policy. This will support ICSs to improve the health of their populations, reduce demand on the NHS and to meet their duty to address health inequalities.

Our message to Government

Creative health offers a different approach to health and wellbeing – one which mobilises creative, cultural and community assets, supporting people to live well for longer. Embedding creative health in systems will benefit individuals, communities and public services, ultimately leading to a healthier population and more prosperous society.

Creative health can improve health outcomes and reduce inequalities. It can reduce pressure on the NHS in the short-term through the provision of effective and cost-effective non-clinical interventions that empower patients and reduce demand on services, and in the longer term as part of an upstream approach to health which creates the conditions for people to live healthier lives.

We therefore believe that creative health has a vital role to play in building an NHS fit for the future. The National Centre for Creative Health and All-Party Parliamentary Group on Arts, Health and Wellbeing Creative Health Review, published in December 2023, brings together strong evidence and examples to demonstrate how creativity supports health and wellbeing and can help to tackle some of our most pressing policy challenges.

The Review recommends a cross-departmental Creative Health Strategy which recognises creativity as a key component of a preventative and person-centred approach to health and wellbeing.

Read the Creative Health Review here - https://ncch.org.uk/creative-health-review

Useful Resource

A ‘Creative Health at a Glance’ Resource Booklet (including 10 downloadable posters) has been developed by our Creative Health Associates Programme. The booklet is an ‘at a glance’ resource, designed to quickly introduce health professionals to how creative and cultural activity can support health priorities. The health conditions spotlighted throughout this booklet appear within the NHS’s Core20PLUS5 strategy and are recognised as the ‘Major Conditions' contributing to ill health in the UK (first identified within the 2023 Major Conditions strategy). These strategies make use of national datasets to identify priority populations and health needs for policy and commissioning. Discover more here https://ncch.org.uk/blog/creative-health-at-a-glance