Leadership and Strategy Roundtable
Since the launch of the Creative Health Review in last October, we have welcomed a fantastic range of expert speakers to discuss with us the role for creative health in tackling key policy and healthcare challenges. We have heard many compelling examples of the benefits of creativity for individuals and for systems where creative health has been able to thrive. Whilst there are numerous brilliant creative health programmes taking place across the country, provision is not consistent and the approach is not yet fully embedded into systems in England.
In this final roundtable of the review, we looked at how this could be achieved, drawing on work that has been taking place in NCCH Hubs, and future plans to place Creative Health Associates in an Integrated Care System (ICS) in every NHS region of England. We drew inspiration from Wales, where arts and health coordinators are already embedded across each health and care board, and heard examples of leadership across communities, local and combined authorities and lived experience.
We were very lucky to be joined in the session by writer and poet Surfing Sofas, who performed his creative response to the roundtable theme live.
In Surfing Sofa’s words….
“With good leadership and strategy,
Magic can happen.
But that only happens
When there’s no lack of compassion”
Hear the full performance here.
Spreading and Scaling Creative Health in Systems
Dr Jane Povey, Clinical Lead for Person-Centred Care at Shropshire, Telford and Wrekin Integrated Care System, described the work she has been leading with NCCH to facilitate the spread and adoption of creative health within integrated care systems, building on the learning from NCCH’s Hub programme. Jane sees the current policy context as an opportunity for health systems to work with communities and places to tackle wicked challenges and address inequalities, with ‘the creative health workforce a potential workforce which is in many ways untapped’. A new NCCH programme supported by funding from Arts Council England, will see seven Creative Health Associates hosted in Integrated Care Boards in each NHS region in England to help to map creative health activity and embed it into systems.
As a system lead who will be hosting a Creative Health Associate, Tracey Bleakely, CEO of Norfolk and Waveney ICB, is already convinced of the potential for creative health to ‘make a massive difference, not just on prevention but on acute care as well’. Tracey comes to the NHS from the third sector, where her role as Chief Executive of Hospice UK introduced her to the power of creativity to support patients, relatives and staff, and with successful creative health initiatives already in place in the ICS, she is keen to incorporate creative health further. Tracey noted;
“Health and commissioning has a great deal of power in the system so I think we have a responsibility to pull creative health in, and I don’t think we have an option not to.’’
Deborah Munt and Carol Massey from Ministry of Others have been commissioned by NCCH and the Integrated Care Board in West Yorkshire to investigate how creative health can grow and scale, across the footprint. They have found that spreading and scaling creative health requires not only a focus on delivery and programmes, but also a change in mindset. Rather than considering creative health as a niche activity, delivered on a project basis, we should think of it as a way of working, requiring a specific set of skills and adequate infrastructure. Achieving this will require challenging and disrupting the ways the sectors involve traditionally work.
In mapping the ecosystem for creative health in West Yorkshire, Deborah and Carol have identified a need for ‘collaborative, distributed leadership’ in which leaders across all relevant sectors (including health and care, culture and academia) need to be involved in supporting the ambition, but also supportive in terms of the model and resourcing.
“The strength of creative health is that it operates in the space between, so our leadership and responsibility for the strategy should also be about that space in between and come from all the different sectors involved.” – Carol Massey
To this end, West Yorkshire is developing collaborative hub, which will incorporate a creative health lead in each of the five places, representing the nuances necessary for each area, but also ICS wide functions for where collective thinking and action is more effective. It will also be supported by the Combined Authority Metro Mayor, Tracy Brabin, a commissioner on this Review, who is able to use devolved powers to support creative industries and education.
Arts and Health in Wales – Shifting to an arts and health service within health boards
Embedding creative health posts in Integrated Care Boards is an approach that is well-established in Wales and has demonstrated very positive impacts for individual health outcomes and for the health system. Nesta Lloyd-Jones, Assistant Director of the Welsh NHS Confederation explained the strong partnership that has evolved between the Welsh NHS Confederation and the Arts Council of Wales, which since 2018 has placed a dedicated arts and health coordinator in each of Wales’ seven local health boards.
“The arts and health coordinators have very much been a game-changer in terms of embedding the arts within the health system, and the coordinators understand and engage with health priorities from the inside out.” – Nesta Lloyd-Jones
The posts, which are funded jointly by Arts Council of Wales and the individual health boards, allow coordinators to understand the challenges facing the system and align with strategic priorities, providing effective support to meet the needs of individuals, staff and the system. An independent evaluation of the programme found it to be very successful, at low cost, achieving improvements in health outcomes across prevention, management, treatment and recovery. The partnerships have resulted in the establishment of substantive, permanent posts in most health boards, and the conversation is now turning to how to translate the benefits into long-term strategies.
The Welsh approach has been backed by ministerial support in Government. Furthermore, legislation such as the Wellbeing for Future Generations Act (2015), which requires public bodies to work towards long-term wellbeing targets, including a healthier Wales and a Wales of vibrant, thriving culture, has also opened opportunities for arts and health providers to think differently and work together.
Over the last six years Nesta describes;
“…a shift from a push from the arts to a pull from the NHS, because the NHS can really see the health need and how creative solutions can respond to current healthcare challenges.”
Lived Experience and Community Leadership
Ambitious leadership across health and social systems will be necessary to embed creative health at a system level. But the most innovative and creative approaches develop from the bottom up, through leaders working with individuals and communities to understand their needs, and coproduce the solutions. A system that empowers individuals and communities to develop creative health approaches can reap the benefits.
Practice Manager, Sheinaz Stansfield explained how working closely with communities in Bensham, Gateshead helped her GP practice to overcome the challenge of a high number of patients with pressing social needs, exacerbated in recent years by COVID-19 and the cost of living crisis.
“In my practice, we have turned a burning platform into a burning ambition to engage with creativity to meet the crisis….By being creative in this way, we are managing demand, we are growing, we are surviving, we are thriving, and what we are doing is actually working with communities in a very different way.” -Sheinaz Stansfield
To achieve this it was necessary to meet patients in the ‘liminal space’, working with them to develop personalised approaches to care. The GP practice supported this work, using quality improvement methods to learn on the go. Community navigators (now known as link workers and established in GP practices across the county) were introduced to support people with their specific social needs, and links were made to community assets which could help people to improve their health and wellbeing, for example through a community allotment, or through the provision of community clubs. As the work developed, patients became volunteers, building their own skillsets and eventually taking control of the running of a community centre, providing support for their peers. Working in this way has not only benefited patients, but there has been a decrease in demand for both A&E and GP services, and the practice now has improved links to carers.
Mah Rana is Co-Director of the Lived Experience Network (LENs), a network of people with lived experience of ill health, who believe in the benefits of creative and cultural engagement to individual and collective wellbeing.
“Organisations like the Lived Experience Network give voice to experiences which might otherwise be hidden.” – Mah Rana
Evoking an image of soldiers engaging in craft as they recover from wartime injuries, Mah reminded us that the use of creativity as part of healthcare has a long history, but that recognition of the role of creativity has somehow been lost. Mah linked creativity to agency and empathy, affecting how we see ourselves and how others see us. Whilst active participation by patients in their care and treatment has not always been encouraged, things are changing and creativity is linked to problem-solving, choice, acceptance and belonging, giving people more control over their situation. For Mah, creativity is ‘not an additional extra, it is essential for being well and staying well’, and the lived experience voice is vital if this understanding is to be embedded across systems;
“It is important to see ourselves, people with lived experience, mirrored in the membership of organisations that develop and lead on research and policy.”
Matthew Couper, Co-Director of London Arts and Health and Borough Engagement Officer at the Greater London Authority, used examples from his 20-year career in the field to highlight the impact that creative health can have when artists are able to reach out into different communities and build relationships. There must also be a supporting infrastructure for artists, who often work alone or as part of small organisations, and London Arts and Health provides this network of support across the capital, offering guidance, training and development and networking opportunities. In his role with the Greater London Authority, Matthew is also helping to embed creative health into local ICSs, and to develop a creative health action plan for the city.
“We know that creative health works – It needs support, it needs advocacy and it needs ongoing funding.” - Matthew Couper
The Role of Creativity in a Health Crisis
This roundtable took place in Creativity and Wellbeing Week. We therefore took the opportunity to address the theme of the week ‘What is the role of creativity in a health crisis?’, with our panel members. Prominent in their thoughts were the pressures on the health workforce, and the need to articulate that creative health can be an ally, helping to address the challenges the health service and its staff currently face. Nesta Lloyd-Jones highlighted the role of creativity in supporting NHS staff with their own wellbeing during the pandemic, through programmes such as Cultural Cwtsh (more on the use of creativity to support the NHS workforce can be found in our roundtable on Education and Training – Workforce Development and Wellbeing).
If we think about the question with respect to systems in crisis, a different way of thinking and working is necessary to address 21st-century challenges. The cultural sector has many of the skills needed to do this, and through bringing the health and cultural sector together, and creating environments that allow people to explore creativity within their roles, we can facilitate innovative, co-produced solutions which better meet the needs of our communities.
Mah Rana reminded us of the queues at creative supply shops immediately prior to lockdown, demonstrating that when faced with a crisis, the public are already aware of the importance of creativity and how it can provide occupation and meaningful activity, and improve wellbeing. It is important that we ensure that creative opportunities are accessible to all.
Recommendations – Embedding Creative Health into Integrated Care Systems
Finally, we asked our contributors for any recommendations which will help us to further embed creative health into systems. Suggestions included;
- Shifting what we measure as performance targets to focus on prevention, the wider determinants of health, communities, and what matters to an individual.
- Investment in infrastructure is crucial, and we should not put limits on our expectations or ambitions.
- We need to define, recruit and support the right kind of leadership for a different way of working. Whilst there are inspiring examples of leadership in creative health in this session, this is not yet the norm across the sector.
Tracey Bleakely took the opposite approach, asking;
‘How can we not commission this? How can it not be part of our toolkit?’
We would like to thank our speakers for their thought-provoking presentations, and our audience for their contributions in the chat. The will all feed into the recommendations of the Review.
You can now watch this roundtable, and all the other Creative Health Review roundtables back here >>
Roundtable Agenda & Biographies: https://ncch.org.uk/uploads/NCCH-Roundtable-Leadership-and-Strategy-Agenda-Public.pdf