Creative Health Development, a Blog by our NCCH Director
On November 26th the new All-Party Parliamentary Group on Creative Health will be launched with Dr Simon Opher MP as Chair. Many of you will know that Simon, a Gloucestershire GP, has been a staunch ally and champion of creative health for 20 years, since he first engaged an artist-in-residence in his GP surgery in 2004 and went on to set up ArtLift, the Arts-on-Prescription charity which is part of the Gloucestershire Creative Health Consortium. It is very helpful that Simon is now an MP! The National Centre for Creative Health will provide the secretariat for the new APPG. As long as you are signed up to our newsletter, you will receive information about any related events.
I have been reflecting on the development of the ‘Creative Health’ field over the last 10 years, since the first days of the All-Party Parliamentary Group (APPG) on Arts, Health and Wellbeing, proposed by Lord Howarth of Newport at the 2013 Culture, Health and Wellbeing International Conference and launched by him in 2014, along with other officers including Dr Sarah Wollaston, then MP for Totnes and more recently Chair of Devon Integrated Care Board.
Creative Health – a note on definitions
The change of name from the APPG on Arts, Health and Wellbeing to the APPG on Creative Health reflects the growing use of Creative Health as a broad concept which encompasses arts and health but also the wider cultural sector, heritage, libraries and museums, and aims to be inclusive of all creative activities, such as gardening and cooking, as well as what we define as creative health approaches often designed to shift the culture within health and care, such as creative co-production and creative training and continuing professional development for healthcare professionals. The NCCH definition is here.
In Creative Health: The Arts for Health and Wellbeing, published in 2017, there is a useful infographic which shows the context for creative health including the built and natural environments, everyday creativity, arts therapies, medical training and medical humanities, and of course arts in healthcare environments. The longest established area of this work is in hospitals, and the National Arts in Hospital Network now has 46 NHS Trusts as members, most with arts programmes and arts managers. The recently published report Understanding Creative Health in London, the Scale, Character and Maturity of the Sector has two informative timelines which cover the history of the field from a London perspective, with 1736 as the earliest date! This was when Hogarth painted his murals in St Bartholomew’s Hospital.
Infographic in Creative Health: The Arts for Health and Wellbeing
In the last 30 years, arts-on-prescription has become part of the expansion of social prescribing. I see creative health in a Venn diagram with social prescribing. Creative health initiatives aim to embed creativity within healthcare systems at various levels, from policy to practice, whereas social prescribing and arts-on-prescription are more patient-focused services that connect individuals to external community resources. When cultural and creative activities are prescribed and part of the social prescribing infrastructure, then they clearly sit within social prescribing. This is confirmed by a recent study into the definition of social prescribing[1] which arrives at: “a means for trusted individuals in clinical and community settings to identify that a person has non-medical, health-related social needs and to subsequently connect them to non-clinical supports and services within the community by co-producing a social prescription – a non-medical prescription, to improve health and wellbeing and to strengthen community connections”.
Some recent examples which illustrate creative health activities and approaches that lie outside the sphere of social prescribing referral routes include:
- Approaches to specific social issues at a group level such as Intercultural Roots and the Peabody Trust’s co-produced project using forum theatre in engaging those who may be at risk of domestic violence.
- Creative approaches to public health messaging and encouraging access to health services such as Goodbye Breasts!, an inspiring artistic exploration of breast cancer and the path to recovery.
- Collaborating at scale to deliver work across a region such as the STAR initiative to take dance into schools with a focus on inequalities. Schools were identified via public health data to prioritise underserved areas.
At a systems level the term Creative Health is now being used in a growing number of strategies in Integrated Care Systems (ICSs). These include Greater Manchester’s Creative Health Strategy, West Yorkshire as a Creative Health System, the establishment of Creative Health Boards in South Yorkshire, involving a research project led by Sheffield Hallam University, part of the Mobilising Community Assets research programme, and an in the pipeline NHS Dorset Creative Health Strategy. The latter is in a live process of engagement work with health and culture at the moment.
Whatever terminology we use, we believe that creative health should form an integral part of a 21st century health and social care system, one that is holistic, person-centred, and which focuses on reducing inequalities and supporting people to live well for longer. Its benefits should be available and accessible to all.
The role of the National Centre for Creative Health
For the National Centre for Creative Health, this year is a milestone in our development. Set up in response to recommendation 1 in the 2017 Creative Health report, the NCCH launched in March 2021 and we have been gathering data on our first three years for a soon-to-be-published impact report and meeting our mission and aims to advance good practice and research, inform policy and promote collaboration, helping foster the conditions for creative health to be integral to health and social care and wider systems. Our work on systems advocacy dovetails with our close partners, the Culture, Health and Wellbeing Alliance and their focus on creative health providers and creative practitioners through their 6000 plus members; and with the Lived Experience Network, the LENs, and our ambition to embed working with people with lived experience in everything we do.
The Creative Health Associates Programme, funded by Arts Council England, has been a significant development and step change for integrating creative health into health and care systems. The seven Associates were appointed in the summer of 2023 and continue until March 2025. Hosted by Integrated Care Boards (ICBs), one in each NHS region in England, they have been working closely with health colleagues in population health and health inequality teams to identify opportunities for embedding creative health in strategies ranging from Waiting Well to De-prescribing and Personalised Care. Our Creative Health Champions’ Network of senior health and care leaders has grown to more than 80 in 31 of the 42 Integrated Care Systems. They are an important route to influencing strategic developments within systems and we see the Champions as key to building on the success of the Creative Health Associates Programme.
Creative Health and National Policy
The Creative Health Review, published in December 2023, made recommendations for a cross-departmental Creative Health Strategy. The new Government’s mission-led approach is very welcome in supporting our call for greater collaboration between culture, health, education and local government. Creative health contributes to the government missions, in particular: Kickstart the Economy; Build an NHS Fit for the Future; and Break Down the Barriers to Opportunity.
The Review presents evidence which shows how creative health can enhance the economy by reducing the avoidable costs to the NHS related to preventable illness, reducing the pressure on health and social care systems by supporting people to self-manage their health and enabling people with long-term conditions to return to or remain in work, thus contributing to economic productivity. In our recommendation to DHSC, we argue that a dedicated creative health plan will contribute to Integrated Care System responsibilities to improve health outcomes and address health inequalities, and will support the development of sustainable partnerships across systems, including with the cultural and VCSE sectors, as part of a joined-up, place-based approach to population health.
The chapter on creative health in the education system provides ample evidence that, as well as producing the creatives of the future, creativity as part of school life provides children with a broad range of transferable skills and improves their future outcomes. The NCCH was pleased to contribute to a recent Department for Education roundtable on the evidence relating to mental health in schools, making clear that engaging in creativity can enable children to develop the emotional resilience that helps them to thrive.
The Creative Health Review makes a recommendation to Combined Authorities to embrace creative health in their plans to improve health, wellbeing and economic prosperity for their populations. With greater devolution the direction of travel, and further devolution deals expected in the near future, Combined Authorities will be an important strategic convener of creative health. A great example of leadership in this area is the partnership between West Yorkshire Combined Authority and the Integrated Care System as mentioned above.
Looking Forward
With the Darzi Review of the NHS in England, the public consultation on the 10 Year Health Plan for England and discussions about a Neighbourhood NHS, prevention and community are front and centre. Our GP and Pharmacy Special Interest Groups are a direct connection to Primary Care. The possibility of a National Care Service has been mooted but social care is still the Cinderella of health and care. As we move into the next phase of the NCCH’s work it is likely we will have a greater focus on the wider Integrated Care Systems and how we can contribute to integration of health and care at a neighbourhood level.
Our wonderful founding Chair, Lord Howarth, stepped down as Chair of the organisation in July and we welcomed Professor Martin Marshall CBE as our new Chair. Martin brings valuable experience from his previous roles as Director General in the Department of Health and Chair of the Royal College of General Practitioners as well as current Chair of the Nuffield Trust and Emeritus Professor of Healthcare Improvement at University College London. Lord Howarth has become NCCH Honorary President and will continue to support the work in his role as Vice-Chair of the new APPG.
At its first meeting, the APPG will elect the Officers and set the agenda for the year ahead.
What would you like the APPG to focus on over the coming months? Submit your ideas here. Deadline 25th November.
Written by Alex Coulter, NCCH Director
References: [1] Muhl, C., Mulligan, K., Giurca, B.C. et al. Building common understanding: seeking consensus and defining social prescribing across contexts – a collective commentary on a Delphi study. BMC Health Serv Res 24, 1280 (2024). https://doi.org/10.1186/s12913-024-11603-x
