AHSW's Director, Trustees, and Members reflect on various aspects of arts, health and wellbeing.

Social Prescribing and Arts on Prescription

Alex unpacks some of the complexities surrounding Social Prescribing and Arts on Prescription.

The Creative Health report references a number of social prescribing and arts on prescription programmes. One of the endorsements in the inside front cover, by Dr Jane Povey, states:

“At least one third of GP appointments are, in part, due to isolation. Through social prescribing and community resilience programmes, creative arts can have a significant impact on reducing isolation and enabling wellbeing in communities.”

Creative Health Recommendation 6 is: 

We recommend that NHS England and the Social Prescribing Network support clinical commissioning groups, NHS provider trusts and local authorities to incorporate arts on prescription into their commissioning plans and to redesign care pathways where appropriate.

At a round table on Recommendation 6 in March 2018, Sir Sam Everington, Chair of NHS Tower Hamlets Clinical Commissioning Group, and founder of the Bromley by Bow Centre, said that loneliness was now a priority concern for GPs. Typically, people will have a mix of issues that lead to them making an appointment with their GP and there are many reasons why health professionals might ‘prescribe’ a social activity rather than medicine. In my local surgery, the headline list for social prescribing is: lonely; money worries; language barriers; frail & elderly; bereaved. Aesop recently commissioned a survey from ComRes who interviewed 1002 GPs online. They found that 66% agree that public engagement with the arts can make a significant contribution to the prevention agenda, but only 44% agree that arts-based interventions can be a cost-effective way to deliver primary care to the public to improve health outcomes. This number is lower in rural areas.

Arts and cultural organisations have varied experiences in relation to social prescribing and many express concern at the apparent lack of funding for the delivery of activities. Statutory funding tends to be targeted at setting up the mechanism for social prescribing and employing a link worker or social prescriber who can help people to identify and join appropriate groups or activities on offer locally. One of the most well-known schemes is Health Connections Mendip which attracted national attention following George Monbiot’s article.

I spoke to Jenny Hartnoll, the dynamo behind its development, about whether arts and culture provision was part of their offer (which it isn’t) and she said that, in her experience, issues of stop start funding and sustainability were a challenge. On the other hand, in the south west we have the example of Gloucestershire Clinical Commissioning Group which is committed to arts and culture throughout its services and to supporting the development of the infrastructure for delivery by the arts and cultural sector. They have two levels of engagement, ‘universal social prescribing’ and ‘social prescribing plus’. The universal social prescribing model is shared with the voluntary sector and the NHS so that there’s access across the county. Social prescribing plus is integrated into clinical care pathways. The Creative Health report includes case studies on Gloucestershire Clinical Commissioning Group’s social prescribing programme and the Artlift arts-on-prescription scheme.

There is no systematic way in which social prescribing schemes are developing, although there is now considerable guidance being provided to GP surgeries by both the Social Prescribing Network and NHS England. Consistency is being built in as schemes develop. Bristol provides an interesting example of this. The Arts on Referral schemes across the city began many years ago and they have gone from strength to strength. They are now grouped together under the banner of the Bristol Arts on Referral Alliance, or BARA.  Southmead hospital has also established an arts on referral scheme for patients with early diagnosis dementia, cancer and chronic pain. This may be the only example of arts on referral (or on prescription) happening inside an acute hospital. The idea is to link up to BARA so that patients can continue to engage once they have been discharged from hospital. Sue Moss, Social Prescribing lead for Bristol City Council, is also a lead for the social prescribing strategy across South Gloucestershire, Bristol and North Somerset (the Sustainability and Transformation Partnership or STP). She told me that they are aligning measuring and monitoring tools so that all the arts on referral schemes can fit into the wider social prescribing programme across the city. We can envisage that this could then be spread across the whole STP footprint, although delivery capacity on the arts and culture side will be a challenge.

Another issue is whether arts and cultural organisations are, or aren’t, connected in to other providers. As well as sports and physical activity, the environment sector would make natural partners.  In June, Rebecca Pow, MP for Taunton Deane, hosted a meeting in parliament with the Royal Society of Psychiatrists. The event was attended by many environment and wildlife organisations, which reflects Rebecca Pow’s background as a journalist specialising in environment, farming and gardening.

The recent NHS funding announced for social prescribing schemes includes two, as far as I know, that involve arts and culture. They are led by Volunteer Cornwall and Age UK Sunderland. In Cornwall, the funding is for six community connectors, one of whom will have an arts focus; in Sunderland, Equal Arts have helped set up arts groups that people with dementia can be referred to. We are beginning to see cultural strategies referencing social prescribing, such as Stoke’s, and of course, Darren Henley wrote about it in a recent Arts Council blog.

If you are working with schools and young people’s mental health, you may know about Arts and Minds’ Art of Resilience programme providing arts on prescription for young people in schools in Cambridge. They have had some positive initial results and the scheme is being rolled out across the county with the support of Cambridgeshire County Council. Arts and Minds have worked with the LSE on evaluation of the cost benefits of arts on prescription for adults.

If you are looking for evidence, this systematized review was published in June 2017: Helen J. Chatterjee, Paul M. Camic, Bridget Lockyer & Linda J. M. Thomson (2017) Non-clinical community interventions: a systematised review of social prescribing schemes, Arts & Health,10:2, 97-123, DOI. The review focuses on evaluation of United Kingdom social prescribing schemes published in peer-reviewed journals and reports. Outcomes included increase in self-esteem and confidence; improvement in mental well-being and positive mood; and reduction in anxiety, depression and negative mood. Other links related to the above review by the key academics working in this area

this radio 4 programme features Dr Marie Polley, Co-Chair of the Social Prescribing Network explaining how it works.

Alexandra Coulter

Director, Arts & Health South West

September 2018

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