Roundtable on Education and Training: Creative Health, Workforce Development & Wellbeing
In the second of our Creative Health Review roundtables on the theme of Education and Training, we looked at workforce development and wellbeing, and considered the extent to which creative health is incorporated into training for healthcare professionals, training and professional development in creative health and the role for creative health in improving workforce wellbeing.
To start the session, our chair, Nancy Hey, Executive Director of the What Works Centre for Wellbeing and NCCH Trustee, reminded us of a recommendation from the 2017 All-Party Parliamentary Group on Arts, Health and Wellbeing Report ‘Creative Health’.
“We recommend that the education of clinicians, public health specialists and other health and care professionals includes accredited modules on the evidence base and practical use of the arts for health and wellbeing outcomes. We also recommend that arts education institutions initiate undergraduate and postgraduate courses and professional development modules dedicated to the contribution of the arts to health and wellbeing.”
In assessing our progress towards this recommendation, Victoria Hume, Director of the Culture, Health and Wellbeing Alliance highlighted a gap in training for practitioners working in creative health. Initial results from CHWA’s National Creative Health Survey indicate that although practitioners would like more professional development opportunities, lack of resources mean that training is both difficult to develop and undertake.
Whilst more universities are showing an interest in creative health, the majority of practitioners currently come to the field as a result of their own experiences rather than via higher education training. Practitioners can access some specialist training opportunities, short CPD courses and toolkits and guidance, but few undertake longer-term higher education courses. A forthcoming Creative Health Quality Framework could underpin future training opportunities.
Victoria also highlighted an ongoing need to ensure a diverse and representative workforce, highlighting programmes such as the Artists Represent and Recovery Network in London which supports the professional development of ethnically diverse artists working in arts and health.
Creative health training within health education
“The arts can make a powerful contribution to the education and development of healthcare professionals at undergraduate and postgraduate level, and to professional development and training.” - Creative Health (2017), quoted by Dr Claire Howlin
Dr Claire Howlin and Dr Ranjita Dhital from University College London gave us an overview of the scope and extent of creative health education across healthcare professions, with the interim findings of their scoping review. Taking the recommendation from ‘Creative Health’ as a starting point, the review of existing peer-reviewed literature investigates how and why creative health is currently being used in education and will identify what is missing and what our next steps might be. Analysing over 300 papers, the review has identified the use of a diverse range of creative practices including poetry, theatre, dance, film, photography and drawing. The review also identified a desire from healthcare professionals to understand more about creative health. However, the results so far indicate a lack of focus on patient-centred outcomes, even in areas where we know there is good evidence for creative approaches. There were also fewer studies linked to allied health professionals, who have a key role in implementing creative health. Claire and Ranjita recommend a future focus on these areas, as well as support and leadership in advocating for creative health education from bodies such as Royal Colleges, to complement the grassroots movements already in place.
Nick Ponsillo, Director of the Philip Barker Centre for Creative Learning and Professor Vicky Ridgway, Associate Dean in the Faculty of Health Medicine and Society at the University of Chester told us how they had embedded creative health across the nursing and midwifery curriculum.
“Holistic experience is the only way to understand the benefit and impact of the work, by doing it. A seeing is believing attitude” – Nick Ponsillo
Using the recommendation from ‘Creative Health’ to make the case, Nick worked with the programme planning team, establishing a programme aim for students to ‘develop an understanding and practical experience of the arts in varying health and social care environments’, and thereby embed creative practice into the processes of healthcare professionals. Students use a range of creative techniques including sketchbooks for reflexive practice, dance and movement to understand the impact of touch and their physical impact, and theatre as embodied learning and immersive simulation. Additionally, students undertake placements and residencies with artists and organisations using creative health and social prescribing which allow them to understand the real-world application.
Vicky described the initial challenges of developing understanding with academic staff and students around the value of creative health, and after some pushback in the pilot phase, they now find students have a greater understanding of the wider determinants of health, the potential of creative health, and how it can be incorporated into their own practice. Students have also used the techniques to maintain their own health and wellbeing. Within the course, activities have been mapped to national proficiencies, but Vicky and Nick recommend an update to professional standards to include creative health in order to achieve wider adoption into the curriculum.
Hamaad Khan, a student leader at the National Association for Social Prescribing (NASP) described the successful efforts of medical students to incorporate social prescribing into the medical curriculum, as part of a bottom-up, student movement to recognise the value of holistic, patient-centred care.
“We realised that the most healing medicine wasn’t always pills and therapies…medicine at its most healing form could also be a drama workshop for elderly and isolated dementia patients, or a financial support and advice service to ease anxiety, depression and suicidal thoughts in certain patients we saw in clinic…” - Hamaad Khan
The student champions network has representatives across every region of England and, thanks to their efforts, social prescribing is now represented in all UK medical schools, at different levels of maturity from peer-led learning to formalised modules. The group is now also working internationally, with the aim of informing healthcare education and future clinical practice on a global scale, most recently with the publication of the Social Prescribing International Student Movement Framework.
Creative health can also be used in medical education to support the wellbeing of medical students themselves. Dr Louise Younie and medical student Sivakami Sibi describe the use of creative enquiry to support flourishing, a concept that Louise has worked to develop in this field for many years. Through expressive arts, medical students are able to explore lived experience and compassion. This can develop an understanding of person-centred care, but in the context of the pandemic and high levels of burnout in medical students, also provides the students themselves with tools to express emotions, fears and vulnerabilities in a safe space. Flourishing, in contrast to resilience, provides students with ‘a kinder way to grow’.
“I hope my peers will get the opportunity to see how important the human dimension is for a practicing doctor. Potentially the arts have a way of showing this as art can help people who are less open to express their experiences that are too hard to put into words. It can also help them to escape from difficult experiences through focussing on an engaging activity, or even simply have positive effects on our wellbeing.” – Sivakami Sibi
For Sivakami, who began her own medical training during COVID-19, the creative enquiry sessions helped her to develop the ability to both listen and express her own emotions. Moving into clinical practice, she has found the work has helped her to consider the needs of her patients holistically. Using creative enquiry has emphasised the ‘human dimensions of the medical’. It provides a safe space for conversations, nurtures compassionate individuals and facilitates a greater focus on lived experience and the formation of deeper connections.
Creative health and workforce wellbeing
Louise and Sivakami showed how creative approaches as part of the medical curriculum can be used not only as an educational tool, but also to improve the health and wellbeing of students. Creative arts programmes can also support NHS staff wellbeing. As Laura Waters, Head of Arts at Air Arts, the arts programme for the University Hospitals of Derby and Burton, described, this is much needed in a context where a high proportion of staff are experiencing stress and burnout, and this is having a significant impact on recruitment and retention. During the pandemic, many people in the hospital setting turned to the arts to support their wellbeing, sparking a huge increase in demand for Air Arts resources.
“With the wellbeing choir, it is a time to enjoy uninterrupted time for you, and to be in sync with those around you, knowing that you are safe and secure.” - Participant in the wellbeing choir, quoted by Laura Waters
In University Hospitals of Derby and Burton, arts clubs were established to allow staff to participate in singing, drawing, photography and crafts. The clubs provided a distraction from work pressures, built a margin into busy lives, and were found to improve wellbeing and morale. Members improved their skills, met new people and were given the opportunity to display their work in the hospital setting or perform publicly. The clubs became ‘mini-communities’ cutting across traditional workplace hierarchies. Acknowledging the long-term psychological impact many staff felt having worked through the pandemic, clubs were established with the existing wellbeing team, which allowed pathways for access to further psychological support and therapies where necessary, and provided a safety net to allow people to discuss their feelings openly.
For Laura, the focus on the value of the arts for wellbeing during the pandemic opened the door for further support for NHS staff. The work embedding a ‘Creative Health Service’ across University Hospitals of Derby and Burton could be replicated in other hospital trusts, and Laura recommends that a research programme looking into the impact of these kind of initiatives would help to spread and scale the work.
Dr Gail Allsopp, Executive Medical Director at the British Association for Performing Arts Medicine (BAPAM) reminded us that it is essential to look after the health of those delivering services, and that this includes performers. BAPAM Chief Executive Claire Cordeaux introduced the work of BAPAM and highlighted that 75% of performers will suffer from an occupational health issue at some point. This could be musculoskeletal, related to vocal or hearing problems, or, increasingly, issues with mental health. Physically demanding schedules, and freelance careers can add to the risks for performers. In addition to providing free health consultations and patient care, BAPAM carries out research into risk factors and care pathways, provides advice and education on prevention, and develops supportive communities of practice.
Training for creative health professionals
Victoria Hume’s opening presentation highlighted that creative health practitioners would like more opportunities for training and professional development. One avenue is a new Master’s programme at UCL, the MASc in Creative Health. Hannah Sercombe graduated in 2022 as part of the first cohort. She told us how, as a qualified Occupational Therapist, further study in creative health allowed her the opportunity to explore her specific interest in creative practice, introduced her to creative research methods, and provided a grounding in co-production and lived experience. As someone new to the field, Hannah benefited from the opportunity to meet and develop relationships with key stakeholders both in leadership roles and carrying out grassroots activities. Building on her experiences, along with another current MASc student, Hannah has gone on to establish a network, ‘Creative RoOTs’ to support occupational therapists with an interest in creative health to further their own creative practice.
In our final presentation, Julia Puebla Fortier provided an overview of her research investigating the training needs of creative health practitioners facilitating sessions for people with complex health or social needs. This work brought joy and satisfaction for practitioners. However, there are challenges, in particular around meeting the needs of participants, behavioural challenges in the sessions, responding to disclosures or challenging stories, and sometimes dealing with suicidality. Julia’s research revealed an ambiguity around the role and responsibility of the practitioner, a lack of standardised training or guidelines, and inadequate support for the emotional work that goes into facilitating these types of sessions. A professional development framework, including core competencies that address these challenges was one recommendation. Furthermore, building support into delivery contracts could help to mitigate some of the emotional impacts of this complex work. Julia is now going on to develop a learning programme in this area with Arts and Health South West, and a WHO resource into Arts Practice and the Ethics of Care.
Recommendations
Our speakers in this session covered a broad range of topics and some key recommendations emerged from the discussion:
- The health and wellbeing of practitioners should be prioritised. In relation to the NHS workforce, hospitals can embed creative health practice into their wellbeing offer.
- Further professional development support is necessary for people working in creative health. Investment in this area from statutory partners such as Integrated Care Boards could help to develop this.
- Creative health should be embedded in medical and healthcare education at undergraduate and postgraduate level. Specific creative health outcomes should be incorporated into professional standards. This would ensure creative health was represented across the curricula.
- Creative health practice is taking place across different healthcare disciplines, including allied healthcare professionals. Development of a shared language and improved communication across disciplines could help to promote collaboration.
We are grateful to all our speakers for sharing their expertise, and we look forward to working with our commissioners to develop recommendations which incorporate their suggestions.
The roundtable is available to watch back here and we welcome your own perspectives and experiences through our open call for contributions – find details of how to submit here.
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