Creative Health and the Health and Care Bill
As the Health and Care Bill moves through Parliament, NCCH Chair, Lord Howarth of Newport, has been advocating for the role of non-clinical and creative approaches to health as part of a restructure of health and care services in England, and highlighting the vital role creative and cultural organisations are already playing.
What will the Health and Care Bill do?
The Health and Care Bill will place into legislation reforms to the way the health service in England operates. The Bill builds on the NHS Long Term Plan, which promotes further integration of a range of providers into the healthcare system through the establishment of Integrated Care Systems (ICSs). These are partnerships across broad geographical areas comprising of the NHS, local authority, the voluntary, community and social enterprise (VCSE) sector and other relevant organisations, which will be responsible for the commissioning and delivery of healthcare services based on local need. The ICS will be made up of an Integrated Care Board (ICB), a statutory body responsible for commissioning in the ICS area, and an Integrated Care Partnership (ICP), a broader alliance of stakeholders concerned with health and wellbeing. Through this approach, it is hoped there will be a greater emphasis on prevention of illness, and tackling the wider determinants of health and health inequalities.
The Role of Creative Health
This shift towards greater integration and place-based working is an opportunity to maximise the potential of the arts, and to advance the NCCH mission to foster the conditions for creative health to be integral to the health and social care and wider systems. NCCH is working in partnership with NHS England and four ICSs: West Yorkshire; Gloucestershire; Shropshire, Telford & Wrekin; and Suffolk & North East Essex, to develop a toolkit to support ICSs to embed creative health across their systems. We welcome the emphasis on joined-up working in this new approach, and the flexibility to respond to local conditions afforded by the Health and Care Bill. However, the role for non-clinical and VCSE providers could be further articulated. Lord Howarth therefore tabled a set of amendments at the committee stage of the House of Lords proceedings on the Bill, intended to ensure the involvement of non-clinical providers across all functions of the ICB. You can watch Lord Howarth introduce these amendments in his speech in the House of Lords on 20th January here. Additionally, Lord Howarth spoke in support of amendments focussing on mental health, health inequalities, palliative care, procurement and commissioning procedures, research, the role of carers and support for people with dementia, backing our call for further representation of the non-clinical and VCSE sector within the Bill with a wealth of evidence and examples demonstrating the impact and effectiveness of creative health. Some of the key opportunities for creative health are explored further below.
Personalised Care and Social Prescribing
Among the avenues highlighted for creative health during the debate, social prescribing has been recognised in the NHS Long Term Plan, which sets a target of 900,000 referrals to social prescribing schemes by 2023/24 as well as by the Department of Health and Social Care, which has invested in the National Academy for Social Prescribing (NASP). Social prescribing provides opportunities for people to improve their health and wellbeing through non-clinical activities, and can be particularly relevant for patients with long-term conditions, complex needs, mental health conditions or experiencing loneliness. In his speech, Lord Howarth drew attention to a strong evidence base for the use of the arts in prevention and management of disease, and cited evaluations of long-running arts on prescription services which, in addition to evidencing the positive health outcomes, demonstrate the cost-effectiveness of such approaches through reductions in GP and other healthcare appointments and wider social benefits.
The value of arts on prescription programmes was supported by personal testimony from NCCH Trustee Debs Teale, a participant in South West Yorkshire NHS Trust’s Creative Minds programme, who has now spent nearly ten years medication free;
“I am eternally grateful to…Creative Minds for giving me the wonderful opportunity to discover a mind released from the fog of depression.”
As the health service struggles to recover from the impact of the pandemic, non-clinical and creative approaches to health can provide an effective and cost-effective route to keeping people well. However, in order to maximise this potential, the importance of the role of these non-clinical providers should be explicitly recognised, and adequate funding and support should be made available through the new ICS structure.
Research, Innovation, Education and Training
The Bill places a requirement for Integrated Care Boards to promote innovation, medical education and training and research related to health services. NCCH believes this should extend to evidence obtained from engagement of its population with creativity and culture, the natural environment and non-clinical activities designed to promote health and wellbeing.
Creative approaches to health are innovative and respond flexibly to individual and community needs. This has been exemplified by the response of the creative and cultural sector to COVID-19, in which creative practitioners found ways to support the physical and mental health of those most affected by isolation and loneliness, as shown in the Culture, Health and Wellbeing Alliance Report ‘How creativity and culture is supporting shielding and vulnerable people at home funding COVID-19’, referenced by Lord Howarth in the debate.
Evidence for the impact and efficacy of such approaches is provided through an expanding research field, which can be drawn upon to support further commissioning of creative health. During the debate Lord Howarth highlighted an evidence summary on the role of arts and health in improving health and wellbeing produced by UCL for the Department of Digital, Culture, Media and Sport, and a World Health Organisation (WHO) Scoping Review collated by Dr Daisy Fancourt and Saoirse Finn. There is international interest in creative health, as evidenced by the establishment of a WHO Collaborating Centre for Arts and Health at UCL and decision-makers in the health system should be aware of recent developments. The NCCH will support further research into the scaling and expansion of creative health interventions, including through partnerships with Academic Health Science Networks, and disseminate the results to advance good practice and inform policy.
Lord Howarth also took the opportunity to reference the work of pioneering medical schools, such as University of Exeter, which incorporate creative practice into their curriculum.
Work by Professor Sir Michael Marmot and the Institute of Health Equity has shown that health inequalities have been widening across England, and the pandemic has both exemplified and amplified these inequalities. Through the focus on integration of a wider range of providers in a place-based approach to healthcare delivery, the Bill provides an opportunity to address the wider social determinants of health - the social, environmental and economic conditions in which people live and work - and therefore reduce inequalities. It has been argued in the House of Lords that a stronger emphasis should be placed on the duty to reduce inequalities.
The creative and cultural sectors have a key role to play in reducing health inequalities, as acknowledged by Michael Marmot in response to the findings of the All Party Parliamentary Group on Arts Health and Wellbeing inquiry, Creative Health. Non-clinical and VCSE activities should be fully embedded at health systems level and an integrated approach to healthcare provides a gateway to achieve this. Through research carried out by the UKRI funded MARCH Network, we know that there are significant health benefits to engaging with cultural and other community activities for everyone, but these benefits may be greater for those who live in the most deprived areas, often the people who are least likely to engage. Targeted investment in cultural and creative opportunities in communities where it can have most benefit will help to reduce health inequalities.
During the House of Lords debate Lord Howarth provided illustrative examples from across the UK of cultural and creative organisations working with communities to improve health and wellbeing outcomes. NCCH will host an AHRC funded research project ‘Mobilising Cultural and Natural Assets to Combat Health Inequalities’ led by Prof. Helen Chatterjee MBE, which will investigate the conditions necessary to scale-up successful community interventions at systems level, the outputs of which will support ICSs to utilise this vital resource.
As the Bill moves forward, priority areas arising from the debate will be taken forward to the Report Stage, expected at the end of this month, during which Lord Howarth will continue to advocate for the importance of health systems embracing the role of non-clinical and VCSE providers, including those delivering creative health.
As the ICS structure is adopted in legislation, and different areas determine their make-up based on local needs and priorities, NCCH will continue to work with local leaders to facilitate the integration of creative health at a system level, providing tools and resources and opportunities to share learning. The Health and Care Bill provides a framework in which to build strong partnerships between the health and creative sectors, but success will depend on a recognition of the value of creative health from leaders within the system and sufficient support for practitioners to work effectively within the ICS.
Find out more about NCCH’s work with ICSs here.
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