An artist a day keeps the doctor away - working with the NHS to commission culture

(c) Joe Magee for Create Gloucestershire

Are drugs and surgery the only way to stay healthy and well? Most people would agree not and yet if an alien were to take a look at current health spend in the UK they would be hard pressed to conclude otherwise.

 NHS Clinical Commissioning Group in Gloucestershire (GCCG) and Create Gloucestershire are embarking on an ambitious journey together looking at alternative approaches to this medicalised model of health. The project is part of the Arts Council England-funded Cultural Commissioning Programme, for which Gloucestershire has been selected as one of two UK pilot regions - the other is in Kent.

Here Pippa Jones, Director of Create Gloucestershire, reflects on the journey to date and the challenges ahead.

 While Gloucestershire has a strong history of arts and health work we are a long way from arts and culture being prescribed as normally as drugs and surgery - and even further away from a time when people have a daily "dose" of arts and culture to build and then sustain healthy and meaningful lives.

Over the last 10 years several art and health interventions have worked successfully across the county. We have strong evidence from these that arts and cultural "prescriptions" bring benefits both to patients and cost savings to the NHS (evaluation available here).

Dr Simon Opher, a pioneering GP from Dursley, was one of the first to notice that repeat visits from patients decrease when they were involved with Artlift.  “A lot of consultations with a GP take place now because, frankly, there is nowhere else for people to go and talk and express their loneliness or frustrations. The GP is being used as a spiritual leader in a sense, but because they are medically trained, they often respond by medicalising a problem, which, in turn makes the patient more reliant on them. In an analysis of the work of Artlift in Gloucestershire it was found that if patients are referred to an artist, then their consultation rate with GPs, the number of times they make a GP appointment, reduce by between 24 and 37%.”

 Passionate stories from participants confirm the arts appear to reach parts that drugs and/or psychological treatments don’t: “I was struggling, but no-one could help me; I felt I had fallen through the cracks. I was very depressed, very suicidal.It took two years to find this class. I am not particularly artistic but that isn't the point. The weekly Artlift session gives me stability, I feel safe here, and there is no agenda. As a complement or supplement to medication, it is second to none. As such, this treatment could easily replace medication entirely; its effects are cumulative and longer lasting than tablets.” – Adam, Artlift client.

 Our key challenge In Gloucestershire (which appears to be shared by other colleagues across the UK) is that, despite a body of good local practice and evidence, backed up by numerous national and international studies, it still feels we need to make the case for arts and culture.  Several factors appear to feed this:

 1.  The burden of evidence for new and innovative interventions is much higher than those that are established and have been funded for many years. According to Dr Simon Opher, “A recent meta analysis of all the data concerning the use of antidepressants like Prozac or Citalopram, showed that there was no difference in their effect compared with placebo. Yet even so a huge number of patients are prescribed these drugs.”

 2. A lack of knowledge and understanding between arts and health sectors which allow stereotypes and assumptions to flourish.  This is exacerbated by a lack of capacity for artists and arts organisations to attend networking meetings held by the NHS or hold platform events that could showcase their work. Compare this with the massive resources of multinational drug companies who can bombard GPs with product-related merchandise on a regular basis.

 3. Arts and health work had been funded on a project-by-project basis, and often for a short-term period; there is a pernicious cycle here. Commissioners ‘pump prime’ or ‘pilot fund’ because the threshold of evidence to sign this off is lower, but this offers less opportunity for long-term robust evaluation. In addition each organisation collects data individually making synthesis and analysis across a range of projects impossible.  

 I am mindful of the massive culture change we are looking at. It will require bold and persistent leadership to bring off.

Invaluable support is being provided by Julia Slay at think tank New Economics Foundation, who are helping us to craft a compelling and logical story of change with indicators to show we are going in the right direction.

The shift will need trust and mutual respect as much as evidence. Trust is built by relationships, not via reports or research, and so our first priority is to broker more opportunities for artists and NHS commissioners and health professionals to meet up and share ideas and thinking. The work in Gloucestershire is going to be led by Jules Ford, our project manager who has both a clinical and an arts background- hopefully a good place! We will be doing regular project updates on our website so if you are interested visit www.creategloucestershire.co.uk to find out about our progress and learning.