Commissioning creative health – One Gloucestershire’s approach

Gloucestershire has a long history of supporting creative health initiatives. Building on the work of some early clinical champions of arts in health, and a strong local arts sector, the former Clinical Commissioning Group (CCG) was able to explore and expand creative health commissioning through the Arts Council England Cultural Commissioning Programme and has since embedded cultural commissioning more fully into its approach. Gloucestershire is one of four NCCH Creative Health Hubs, which have explored how best to create the conditions for creative health to thrive at Integrated Care System (ICS) level.

How and why has creative health been embedded into Gloucestershire ICS?

Creative Health in Gloucestershire ICS falls under the Enabling Active Communities programme, and is conceived of as ‘a continuum of intervention to meet a continuum of need’. This recognises the role of the ICS in not only tackling clinical conditions for which the NHS is directly responsible, but also addressing health behaviours and the psycho-social and wider determinants of health which account for a large proportion of ill health. Gloucestershire recognises a role for the ICS as an anchor organisation to address health and wellbeing across this spectrum, with creative health having a role to play across all domains.

Cultural commissioning in Gloucestershire is sometimes considered ‘social prescribing plus’, with the population able to access creative health not only through arts on prescription, which connects people to community initiatives to address a non-medical need, but also part of a universal health and wellbeing offer to the population and as part of care pathways providing a non-medical intervention to address a clinical need.

A range of creative health activities have been co-produced with patients, artists, clinicians and commissioners to address specific needs, and have shown positive impacts for both patients and the system. For example, visual arts, circus skills and music making have been used with children and young people with long term mental health conditions to improve adherence to medication but also to improve psychological wellbeing, self-esteem, confidence and social connection. This programme, delivered by Art Shape, Artspace Cinderford and The Music Works, reduced anxiety for participants, and led to significant reductions in healthcare utilisation post-intervention. Mindsong’s Singing for Breathing programme, in addition to the physiological benefits to lung health, has improved life satisfaction and happiness for adult participants and reduced emergency admissions by 100% at 3 months post-intervention and 78% at 6 months. The need for out-of-hours services for this group has been reduced due to people having more confidence to self-manage their conditions.

The creative health offer is targeted at the most deprived communities in Gloucestershire, therefore also helping to address health inequalities.

Demonstrating impact

Realising a need to legitimise the approach and demonstrate impact, Gloucestershire has been gathering positive patient experiences and pseudo-anonymised patient data over the long term. They have established what they believe to be the world’s largest dataset of creative health interventions by requiring all providers to input data, and supporting them to do so by building in the admin costs into the commissioning process.

Whilst data collected from each intervention may be a small sample size, outcomes are generated in a consistent way across the programme, also allowing for comparison with other clinical interventions. Information about healthcare utilisation, outcome measures, attendance, referrals and demographics is collected to demonstrate overall impact to the system.

Personal stories, and the opportunity to experience the creative activities has also been vital in generating buy-in from clinicians and senior managers.

“What has been key to me, as a senior leader within my system, to build commitment to the programme, has been about building evidence at scale and over time… the key has been about building confidence in a sustained way, influencing through the dataset but also the testimonies and stories…and then building confidence around their place in the clinical intervention and the health benefits we can demonstrate.” – Ellen Rule, Deputy CEO/Director of Strategy and Transformation, Gloucestershire ICB, Cost-effectiveness, Evidencing Value for Money and Funding Models Roundtable.

Commissioning creative health

Initially, short term pump-prime funding was available to pilot innovative approaches and build confidence in creative health. Recognising the challenges such a model can present to small providers, the CCG (Now the Integrated Care Board) began to mainstream funding for arts on prescription programmes. The ICB is now moving towards further routine commissioning of creative health, so that programmes such as Airlift’s Living Well with Chronic Pain are also an established part of the offer to patients and commissioned on a recurrent basis. The integrated care model has also allowed for the development of a commissioning framework for the VCSE sector to help foster more sustainable partnerships.

The long term approach to evidencing the impact of creative health has made it easier to assess the return on investment, and make the case for diverting resources upstream with a focus on prevention.

Gloucestershire Creative Health Consortium

Support from ICS leadership and commissioners in Gloucestershire has created the conditions for creative health to be effectively embedded into the system. Innovative approaches on the provider side have also helped to make creative health easier to commission, and led to an improved offer for patients as well as opportunities to increase scale and capacity.

Gloucestershire Creative Health Consortium brings together several long-standing creative health providers (Artspace Cinderford, Art Shape, Mindsong, Artlift and the MusicWorks) offering a range of creative health programmes for diverse target populations. This way of working has advantages for consortium members. Members have been able to partner on pilot projects, cooperate to reduce duplication and wastage in the system, share expertise, and find efficiencies across systems and procedures. Acting as a consortium, they can provide a coordinated offer to external partners such as the NHS and local universities. The consortium model also allows the organisations to look at progression pathways across the programmes offered – for example, someone who has benefited from Artlift’s mental health programme can be more easily referred to an employment and skills service offered by Art Shape. Working collaboratively increases access to different funding sources, and initiatives can be more easily scaled up.

The NHS has invested in the establishment and running of the consortium, and benefits from the simplification of commissioning creative health.

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Find out more about NCCH's and the All-Party Parliamentary Group on Arts, Health and Wellbeing (APPG AHW) Creative Health Review >>