Money Talks

2020 was a seminal year for those of us interested in how the arts impact our health and wellbeing.

The pandemic really shone a light on art’s importance in our everyday lives, with research showing that, during lockdown, engaging in creative hobbies was associated with decreases in symptoms of depression and anxiety. Earlier that year, the World Health Organisation published a landmark report, synthesising results from over 3000 studies to identify ‘a major role for the arts in the prevention of ill health, promotion of health, and management and treatment of illness’. And a 2019 study published in the British Medical Journal found that people who engaged with receptive arts activities on a frequent basis had ‘a 31% lower risk of dying, independent of demographic, socioeconomic, health related, behavioural, and social factors’.

Here in Wales, in 2020, we also launched ‘HARP’ – Health, Arts, Research, People. Looking to build on and add to this evidence base, we worked with 17 ‘arts and health’ innovation teams looking to improve health outcomes and transform health and care systems using creativity.  

However, when innovation spans across different sectors – such as health and arts – a particularly sticky challenge for our innovators is how to sustain and scale the best ideas long term. And one of the biggest questions for our HARP teams has been who they should be asking for investment.

Respondents to a 2020 Culture, Health and Wellbeing Alliance survey reported that just 8% of funding for arts and health work is coming from the NHS. The majority – 57% – is coming from grants from trusts and foundations, including arts councils. Such grants are usually one-off, short term and project-specific, with a focus on new ideas rather than embedding or scaling. 

Arts and health innovators often end up moving on to new ideas, which are easier to get that third-party grant funding for, instead of embedding and scaling their existing good ideas

As this area of innovation grows and the evidence that the arts supports our health continues to stack up, we now need public and third sectors across arts, health and social care to recognise how this work benefits them and their populations, and take on responsibility for its long term sustainability through the allocation of long term investment. Here in Wales we have the added incentive of policy agendas like the Well-being of Future Generations Act and A Healthier Wales. These encourage public bodies to move towards viewing our health and wellbeing as holistic.

All this should create opportunities for innovation – like arts and health – that spans traditional public and third sector roles.

However, our HARP teams tell us that in practice their work remains very much on the periphery – and falls between the gaps – of health and arts organisations. While partners view them as impactful and important, they are yet to become essential to their missions and worthy of long term backing. The result is that arts and health innovators often end up moving on to new ideas, which are easier to get that third-party grant funding for, instead of embedding and scaling their existing good ideas within those health and arts places with their partners. So the cycle continues.

On the ground

The case of the ‘Ar Y Dibyn’ project highlights some of these challenges. Led by Theatr Genedlaethol Cymru and artist Iola Ynyr with Literature Wales and Adra (Housing), the team offers creative writing sessions in the Welsh language for people experiencing addiction. The project was initially piloted in Caernarfon and then became a national online project during lockdown, with much success. 

Iala Ynyr explains: ‘One participant has since become a professional writer. And another who was hospitalised asked if they could participate in sessions from the ward because they felt the project was so vital to improving their wellbeing.’

HARP’s funding and support allowed the team to reach more people, while continuing to develop the project and explore new partnerships and funding options.  In the end, after initially engaging in the project as non-funding partners, the Regional Substance Misuse Gwynedd and Môn Partnership Unit agreed to support ‘Ar Y Dibyn’ financially for another block of workshops with potential for further support in the future. Theatr Genedlaethol Cymru is investing some of their own funds short term, too. The partners involved have come to view the project as vital because it offers people something high-quality while they are waiting, often a long time, for addiction support such as counselling. They’ve also commissioned the team to work with some of their most vulnerable populations, such as those in residential care facilities. 

This suggests that accessing health funding is possible for arts and health innovators, if they identify common goals and articulate their value to the right partners. However,  because the funding is again short term, ‘Ar Y Dibyn’s future beyond the next year of funding remains unclear.

Driving innovation – who should fund what?

In our recommendations for investors around The HARP Approach, we ask for a recalibration of the support given to arts and health innovation projects, based on the needs of projects at different stages of their long lifecycle.  But part of this must also be about agreeing who should fund what type of work, and when.

The paradox of the holistic health agenda, as supported by the Well-being of Future Generations Act, may in fact be that in making this sort of work ‘everyone’s’ responsibility, it actually removes the impetus for any one (or more) parts of our public sector to really become accountable for it.

What’s needed is for health and care organisations to be clearer about their roles within this agenda, making it much easier for arts and health innovators to better identify where their priorities do and don’t fit with specific health partners’ (like the Ar Y Dibyn example). 

If health leaders and policy makers would give specific consideration to how different types of arts projects meet their health and care priorities, they could then allocate funding more decisively. The current crises in health and social care surely make their innovations more important than ever: if arts and culture projects that support health and wellbeing truly become part of the ecosystem that not only helps us when we’re ill, but keeps us well for longer, then we have a viable chance at reducing demand on the NHS and social care systems.

If we want a healthier Wales, investing in the arts and creative projects for health and wellbeing is crucial

For example, evidenced arts projects with a specific clinical aim around a particular condition (say, directly improving mental or physical health) are likely to be most suitable for NHS investment. Community-based projects to reduce isolation or improve general well being are perhaps a better fit for local authority investment, with health charities also playing a role in supporting projects that provide psychosocial support to people experiencing particular health conditions.  

This approach can never be a one-size-fits-all, but developing a more common understanding of how projects do and don’t fit with specific partners’ priorities would save everyone involved a lot of time and uncertainty. It would also help innovators to set clear goals for projects, to evaluate better, and to build stronger referral pathways into arts projects. And most importantly, it would lead to the best ideas having more impact on more people.  

Structures for deciding how this could work already exist: in Wales, we have regional partnership boards; in England, the integrated care systems. We would like these places to hold focused, informed discussions where they review the evidence and practice in arts and health and make a commitment to supporting its development.

Informed by this, the next step is for these bodies, supported by Welsh Government, to develop a coherent framework – and secure investment – for areas of innovation that sit in between the traditional roles of the arts, health and care sectors in each place.  The Welsh Government’s development of the Social Prescribing Framework offers a good blueprint for this: the framework maps out the numerous roles and referral pathways around non-medical projects that reduce isolation. It’s not yet clear what investment will follow from this, though the hope is that regional partnership boards will ultimately hold a commissioning budget for local services and projects that take social prescribing referrals.  We would like to see this process, and approach, applied to arts and health, focusing on the particular considerations of creative interventions for health and wellbeing – their practicalities, partners and needs. 

All this would allow for very different organisations and people to work together in these new spaces, explore the opportunities that are created, and make sure the best ideas can survive and grow.  If we want a healthier Wales, investing in the arts and creative projects for health and wellbeing is crucial, and more needs to be done to ensure this becomes a reality. 

Notes

From 2019-2022, HARP – Health, Arts, Research, People – has explored how we can generate, grow and learn about creative innovations that support people’s health and wellbeing. It is an innovation and research partnership between Arts Council of Wales, Nesta and Cardiff University’s ‘Y Lab’, supported by the Welsh NHS Confederation, Wales Arts, Health and Wellbeing Network and People Powered Results.

Find out more about HARP, including project stories, learning, research and recommendations: (Eng) www.healthartsresearch.wales / (Cym) www.ymchwiliechydcelfyddydau.cymru (live from 16 May 2022)

All articles published on the welsh agenda are subject to IWA’s disclaimer.