asked Her Majesty’s Government how they intend to develop their policies to link the arts with healthcare.
The noble Lord said: There is much to celebrate in the contribution of the arts to healthcare across the country. Bibliotherapy groups on Merseyside are enabling literature to alleviate pain and mental distress for people with Alzheimer’s, motor neurone disease and mental health problems. Poems in the Waiting Room is the most widely read poetry publication in the United Kingdom. Live Music Now presents concerts and runs workshops to support people in mental health units, care homes and hospices. The Peninsula Medical School has appointed the distinguished violinist, Paul Robertson, as visiting professor of music and medicine. The Royal Northern College of Music and Arts for Health at Manchester Metropolitan University are promoting collaboration between centres of excellence in musical education and medical education. Paintings in Hospitals, led by Stuart Davie, not only lends from its own collection but runs artists-in-residence programmes and has brokered loan exhibitions to hospitals with the V&A.
Gloucestershire Hospitals NHS trusts Leading the Way programme; Stockport’s Arts on Prescription and Bradford’s Dance for Life have been exemplary. In London, Guy’s and St Thomas’s, under the cultural leadership of Karen Sarkissian, with its beautiful Evelina Children’s Hospital designed by Hopkins Architects; Homerton Hospital, with its arts programme led by Shaun Caton; Bart’s, where the Gibbs grade 1 listed west wing has been reinvented by Greenhill Jenner Architects and enhanced with art commissioned by Vital Arts; and Chelsea and Westminster, where the brilliant tradition established by Susan Loppert continues, are all enlisting the arts creatively and effectively in support of healthcare. Over 100 arts managers are running hospital arts groups across Britain. I look forward to hearing in the debate about Bromley-by-Bow and the King’s Fund’s Enhancing the Healing Environment programme. The document jointly produced by the Department of Health and Arts Council England in 2007, A Prospectus for Arts and Health, describes a wealth of activity.
What are the benefits of linking the arts with healthcare? It is important to make clear that practitioners are not making exaggerated claims. No one is suggesting that you should send for an artist instead of a doctor, or that a poem can substitute for a drug. What is claimed is that the arts can supplement and enhance the efficacy of conventional medical treatments. Dr Rosalia Staricoff’s research at the Chelsea and Westminster between 1999 and 2002 demonstrated that the integration of the visual and performing arts in healthcare induces significant differences in clinical outcomes, reduces drug consumption, shortens stays in hospital, improves patient management, increases job satisfaction and staff retention, and enhances service. In a later review of the medical literature on the arts and health, Staricoff found significant evidence of reduced anxiety and depression during chemotherapy, improved blood pressure and heart rate in cardiovascular patients, improved clinical and behavioural states in intensive care, diminished stress before surgery and less need for pain-reducing medication after it.
The testimony of patients themselves is eloquent. Listeners to “Music Matters” on Radio 3 last Saturday heard a person with bipolar affective disorder speaking of the stabilising effect of making music with other patients, and another person described how it “triggered” in her a wish to sing, which then triggered a recovery process to,
“a level of well-being I haven’t had perhaps for 30 years”.
One person said that music therapy stopped her dwelling on her illness until it became her and she it; another described how music “put a brake” on obsession and compulsion, and another told us how music brought order, beauty and meaning into a life devastated by severe depression.
In recent years, NHS Estates and the Commission for Architecture and the Built Environment have brought about a new realisation of the importance of well-designed buildings and neighbourhoods in preventing ill health, supporting therapy and assisting recovery. Local improvement finance trusts have enabled smaller facilities such as GP surgeries to embody good design standards. CABE’s publication, Designed with Care, presents 15 examples of outstanding design in healthcare buildings, including the remarkable Maggie’s Highlands, designed by Page and Park and Charles Jencks. Functionality and aesthetics are part of each other. Polyclinics will be a very important opportunity to support healthcare through design.
Aside from certain beacons, the arts, however, are still not systematically integrated into normal healthcare throughout the country. Why do the arts remain a voluntary add-on, available in healthcare only where they happen to be championed by energetic enthusiasts? Why do the health service and social services fail so extensively to avail themselves of artists and the arts? One reason has been a paucity of hard research that convincingly demonstrates the therapeutic benefits of the arts and their ability to reduce healthcare costs. Dr Staricoff’s research was a somewhat isolated peak. A research team led by Professor Jenny Secker studied participatory arts projects for people with mental health needs. While the study Mental Health, Social Inclusion and Arts reported a “vibrant sector”, many projects struggled to evaluate outcomes. There was difficulty in demonstrating the specific benefits of the arts as distinct from other factors, samples were not large enough for data-hungry analytical methods and there was a lack of longer term studies.
In some areas, both the quality and quantity of research are now being transformed. With non-intrusive brain mapping, pathways and connections in the brain are being explored with increasing precision to enable us to understand the processes linking, for example, music with emotion and music with anaesthesia. A spate of research papers is casting light on the impact of the arts on neurophysiology. A new international journal Arts and Health has recently been launched. How rapidly will professional attitudes and practice respond? As a society, we still suffer from the “two cultures” split. Doctors who love going to concerts fail to see how music could assist them in the treatment of their patients. Latter-day barber surgeons, the practitioners of high-tech medicine, will, I suspect, be slow to acknowledge any claim for resources by latter-day healers. Public opinion may move faster, given the contribution that the arts can evidently make, for example, to the alleviation of age-related diseases.
Funding on a scale that is very modest in NHS terms would enable the arts to contribute much more extensive benefits to healthcare. As it is, the arts are typically supported by tiny charitable organisations tacked on to hospitals. Even at Chelsea and Westminster, the charitable unit consists of only two people. They have to spend so much of their time and energy raising money to stay in being that they are not able to do the work that they really should do. With the NHS running a surplus, surely money can be allocated to pay for core costs of arts activity within the NHS; for arts commissioners in PCTs and arts co-ordinators in hospital trusts. They will then raise awareness and further funds and engage with artists and arts organisations to plug them into the health service.
Some public funding is also needed for research, training, the exchange of ideas and dissemination of good practice. Fifteen million pounds—the amount recently spent by the Department of Health asking Londoners what they think about the NHS—would really make a difference. It is encouraging that the Treasury is already funding a number of projects under its Invest to Save scheme. The Isle of Wight PCT, for example, is being funded to do research, led by Guy Eades, one of the doyens of arts and health, on the contribution of the arts to the rehabilitation of stroke patients, requirements for primary and secondary care by people with mental illness, and reducing obesity in primary school children.
More than money, what is needed is political leadership. It was, up to a point, pleasing to see the foreword to A Prospectus for Arts and Health signed by Andy Burnham and David Lammy on behalf of the Department of Health and the DCMS. The two Ministers said appropriate things, but somehow that failed to be the endorsement needed. The document was signed by two junior Ministers when it could have had the explicit backing of the two Secretaries of State. Its launch was so low-profile as to be invisible. It was not a serious effort to induce culture change in the NHS.
The energy and creativity will always come locally, but we need to know whether the Government intend to take forward the recommendations in the report of the Review of Arts and Health Working Group, produced by Harry Cayton in 2006. The report urged the Government to make a clear statement that the arts should be recognised as integral to health, healthcare provision and healthcare environments; to create an environment in which it is legitimate and considered to be good practice to invest in arts and health; to make clear that there is a substantial evidence base supporting the use of arts in health; to form partnerships and identify sources of funding; to develop a communications strategy; to develop training to support the increased involvement of artists in the work of the NHS; and to make the arts integral to planning, design and construction.
We also need to know whether the DCMS and Arts Council England are still committed to the strategy set out last year in The Arts, Health and Well-being, which was billed as the first formal national strategy for arts and health. ACE declared two overarching aims:
“to integrate the arts into mainstream health strategy”,
“to increase ... resources for arts and health initiatives”.
Has ACE allocated funds for that? Can we look forward to a renewal of that commitment by Andy Burnham in his new incarnation as Secretary of State for Culture?
Most of all, we need a statement from the Department of Health at the highest level giving permission to chief executives of PCTs and hospital trusts to spend money on the arts in healthcare and otherwise legitimising support for the arts as part of mainstream NHS and social services activity. We need best practice guidance from the department but, most importantly, we need a speech by the Secretary of State, Alan Johnson, energetically promulgated throughout the NHS, that decisively raises the status of the arts in healthcare.
I congratulate the noble Lord, Lord Howarth, on introducing a very interesting debate. In preparation for it, I confess that I have read various reports from the Arts Council and the Anglia Ruskin University/UCLan report on mental health and social inclusion as well as various government documents, and I have been extremely impressed by the amount of research on this subject that has established a positive link between art and healthcare. I have also been impressed by what has already been done—on a shoestring, as the noble Lord has indicated—with operas in hospitals, dancers and orchestras in residence, acting and singing workshops and poets and puppeteers, let alone original works of art. Substantive sums of money have been devoted to them. I applaud all those initiatives and very much hope that they will continue and multiply. I endorse entirely what the noble Lord said about wishing to see the Government take the issue more seriously than they do at the moment.
I want to take up a slightly different issue with regard to the arts and healthcare; namely, adult education. The arts play a substantial part in adult education for older learners in particular. Participation in the arts through adult education has made an important contribution to the physical and mental health of older people. But it is under threat, which is why I am raising the subject. It is under threat because the budget has already been substantially cut. We have already seen a drop of more than 1 million in the number of adults participating in further education over the past two years. It is particularly under threat for the over-65s.
The government budget for adult education over the next three years, announced in the Comprehensive Spending Review, is £3 billion, but that is split, roughly speaking, between £1.5 billion that goes to further education for training and skills up to level 3 and a further £1.5 billion that will go to employers to encourage them to raise their game and get their employees into further training and skills. Within the further education budget there are two lines that relate to what is called “adult safeguarded learning”, or what is now termed “personal, community and developmental learning”. That is straight-lined at £210 million throughout the three-year period. That relates to adult education courses in further education colleges and, particularly, the old local adult education colleges, which in any case have seen savage cuts over the past few years. No more money is forthcoming in real terms. Money is forthcoming, but in real terms there is a drop in the budget.
Perhaps even more alarming is the fact that a further line in the budget called “developmental learning” in further education colleges, which are courses that adults take to improve their skills but which do not necessarily lead to qualifications, is set to drop in the same period from £385 million to £106 million—a substantial drop. As I say, we have already seen the number of adult learners in further and higher education drop by more than 1 million since 2005, and disproportionately among those over 65. Fewer than half of those over 65 who participated in adult education in 2004-05 participated in 2006-07. In the personal community of developmental learning in particular, numbers are down by more than 30 per cent.
Yet we know that learning matters, particularly for older people, whom it helps to keep healthy and mentally alert. The Centre for Research on the Wider Benefits of Learning has shown irrefutably that people who go on learning lead healthier lives and that learning reduces morbidity, delays the effects of Alzheimer’s and Parkinson’s diseases, encourages mental agility and helps to maintain social contact. We also know from the Basic Skills Agency’s Learning with Grandparents project that grandparents who take adult education classes are confident older learners and have the power to inspire younger learners to improve their own performance.
One in five of those over 65 see themselves as learners. A recent NIACE survey of what older people want to study shows that the most popular subject at the moment is, I regret to say, not the arts but computer skills, although the arts come after computer skills and are a substantial group, if one includes foreign languages and history in the definition of arts. Of those who study, well over 15 per cent study the arts and health. Older learners show a passion for learning and a pleasure in the act of learning. They derive considerable self-confidence from learning, which features highly in their motivation.
Satisfaction and an increased well-being in life emerge as an extremely important aspect of learners’ development, so the arts play an important part in helping to keep people healthy over the course of their lives. It is important that we do not forget that. The Government recently issued a consultation paper, on which I congratulate the new Secretary of State in particular because it is very important that we look at this. There is a great danger, as I said when I talked about the budget cuts, that there will be swingeing cuts in the budget for all adult education courses.
I conclude with two quotations from the NIACE survey on older learners.
“Most older adults want to learn and to meet similar minded people. This is wide ranging positive attitude that impacts indirectly into health and social issues. If people are in classes, less will be in hospital! … Ensuring senior citizens have affordable classes and social contact with others will pay off regarding their well-being. This will probably put less strain on the NHS in many areas affecting the elderly”.
My final quote is from a lady who says:
“I have been attending a pressed flower class for a few years and was appalled when told last week that the fees were going up … We were told that the Government want to encourage the 16+ to take exams. As the majority of the class are pensioners I can see the class will fold. I have e-mailed my local MP and asked her if she wants us to sit at home and just wait to die? I thought the Government wanted to encourage pensioners to take part in classes and get out!”
This is an important issue. It is a slightly different issue from that raised by the noble Lord, Lord Howarth, but maintaining people in good health is just as important as helping them to get better when they are ill.
I congratulate the noble Lord, Lord Howarth of Newport, on securing this debate. It is a subject very close to my heart and an area of work I have actively promoted for many years through my work at the Bromley by Bow Centre in the East End of London. I declare an interest as the founder of a centre that has spent 25 years exploring the relationship between the arts and healthcare in the midst of a challenging group of East End housing estates where traditional approaches to health, which have followed the biomedical model, have been far from satisfactory and very costly.
The key question is: what does it mean to be a healthy and fully rounded human being and what kind of services do we need that will help, rather than hinder, such human development? More precisely, do we want to develop a National Health Service or, as I fear we have at present, a national illness service? Yes, it is a fairly good national illness service, but it is expensive and wasteful to focus on illness rather than health.
The problem with an illness service with an ageing population is that the demands upon it are potentially infinite, particularly given the tendency endlessly to pathologise; for example, on happiness, food or weight. The NHS treats these matters as illnesses rather than giving enough thought to how to promote health. Through working with artists and creative people, social entrepreneurs like myself have learnt how to turn these problems into opportunities for health.
One of the reasons we involved artists from a very early stage in people’s healthcare in Bromley-by-Bow, apart from the fact that you can give an artist a derelict room and they think they are getting the earth, is that they bring a space alive. They bring life, health, energy and transformation and they believe that everyone is creative and has potential. One of the key roles of an artist is to engender change and transformation. What does this mean in practice in our health centre in Bromley-by-Bow?
The Bromley by Bow Health Centre has GPs who work alongside artists and a multi-disciplinary staff team who can offer our patients more than 125 different activities each week, the arts being among them. A few of our medical staff are also practising artists. I could give many examples of how they have used the arts to tackle pressing clinical problems such as diabetes, vaccination take-up and iron deficiency anaemia, but there is time for only one. A while ago a number of our doctors began to notice an increase in asthma among our young patients. The traditional response would, of course, be a three-minute appointment and the calming of parents’ fears with the usual medication for their child. The centre's response was to turn the problem into an opportunity for health promotion.
A 10-week course for children with asthma aged five to 11 years was established, run by a practice nurse who was also an artist. She worked alongside one of the centre artists and local volunteers. The course was run after school in the health centre reception, which doubles up as an art gallery, and was attended by 12 to 15 children at a time with their parents. Seeing your child experiencing breathing difficulties is frightening for all parents, particularly if you have no scientific understanding of what is happening in your child's body. First-year medical students on a special study module placement at the centre were also invited to take part.
The workshops were designed and run in three phases: monitoring asthma, trigger factors and controlling asthma. Each week the art produced from the session was hung in the reception area, thus creating an instant involvement with all the participating children and, of course, with other patients. All the children were given a peak-flow diary and recorded their peak flow for the duration of the workshops. During that period the children produced blow paintings with stencilled airway shapes, made airway mobiles and created models of allergens that cause asthma, showing the role played by cigarettes, house dust mites, spray cans and the like. They sculpted a large bronchial chandelier with inhaler colour coding and produced an asthma space station from empty inhalers.
Each of the workshops had an educational component integrated into the art-making activity, and the facilitators ran quizzes to establish levels of knowledge around each of the asthma areas. The findings and benefits were that there was excellent feedback from the children, with clear improvement in their asthma management. The project was evaluated for its impact on the children and their parents, and all the children showed a marked impact to their peak flow. Surgery staff were involved in the reception and the conversations that the exhibition stimulated among patients, local people and staff were countless. Knowledge about asthma, through the medium of art, increased; fear about a frightening illness decreased. Those are clear positive clinical outcomes with equally clear economic benefits to the health service. However, there remains an important need for research into the costs and benefits of that type of intervention. I am told that it would be straightforward to set up clinical trials to gather evidence as to whether or not they are effective.
A number of important unintended consequences also occurred. Parents began to understand the science of their children’s illness, and were thus less fearful and could respond accordingly. Parents, trainee doctors and members of staff came to know each other on first-name terms and new relationships were built between professionals and local people. Who knows which of those East End children might now be thinking about becoming a doctor or nurse in their later life? Who can tell? Indeed, at least one of the medical students was switched on to the idea of a career as a GP for the first time, rather than focusing on the supposedly more glamorous idea of a hospital-based career.
Was the whole exercise about health, the arts, science, education, social care or relationships? Actually, it was about all of them, but none of them in a box. Does it have implications for the noble Lord, Lord Darzi, and his thinking about polyclinics? I hope so, because the Bromley by Bow Centre is probably the first polyclinic. But who knows? Was it cost effective? Yes, and no prescriptions were given out. The final twist was that, as social entrepreneurs, we realised that we could package the course, turn it into a business opportunity, sell it to every school and health centre in the UK and use the money to fund other health projects at the centre.
A key to our success in Bromley-by-Bow was not to use artists who just came in to do things with patients but to encourage artists to live out their real work as artists at the centre. It really works when artists become part of the health community. They live their lives there and have studios there, and their passion for their subject inspires others.
To maximise the opportunities presented by the reforms of the noble Lord, Lord Darzi, we will need to ensure that we provide a health service rather than just an illness service—a service that is about more than just the biomedical model of health, which is very expensive. Twenty-five per cent of patients who have traditionally been seeing our doctors did not need medical help; they needed something else, but ended up with a medical response by default. If all you have is a team of clinicians, whether they are in big central hospitals or dispersed through smaller centres and GP practices, the health service will change very little. This is all about clinicians giving away power and about a broader view of health. What is radical about our work in east London is that doctors and nurses have shown some humility and have been willing to share power with others. Simple things such as a shared reception save so much money.
The £300 million healthy living centre programme was full of opportunities to expand this thinking when it was boldly launched by Ministers in 1997, but it is in danger of withering on the vine because local clinicians were not actually prepared to give up fiefdoms and engage. Institutionally in all its forms the NHS and the Department of Health singularly failed to engage with this important opportunity. One suggests that all that they saw was yet another demand on their resources, rather than an opportunity such as that described in our asthma project, to reduce the drugs bill and the number of hours that expensive clinicians have to spend with patients.
In my experience, connecting the arts and health is good for patients, builds a healthy and dynamic staff team and is very cost-effective. I hope that the report by the noble Lord, Lord Darzi, will embrace this opportunity, which we have spent over 20 years successfully demonstrating.
I, too, pay tribute to the noble Lord, Lord Howarth of Newport, for securing this debate. I declare an interest as former chief executive of the King’s Fund and as someone with a passion for the subject of arts and health.
Everyone here knows that the Government asked Harry Cayton, then national director for Patients and the Public, and an old colleague of mine, to chair the working group on arts and health. That group reported, in a useful piece of work, back in February 2006; two years ago. What has really happened in the mean time, and what is going to happen now? The Arts Council has done useful work, and there is masses happening out there, but the Government’s silence in direct response to this review has been deafening. The noble Lord, Lord Howarth, was right in saying that we need to see some political commitment to this now, taking on board the comments made by the noble Lord, Lord Mawson, and the noble Baroness, Lady Sharp, who said that this is broader than simply being about what goes on in hospitals. We need to hear some commitment from the Secretary of State and others, and we need to see whether the Arts Council is doing the funding that it said that it was going to do.
I am going to talk about the area that I know best, which is the Enhancing the Healing Environment programme, which the King’s Fund ran. I am rather hoping that the noble Earl, Lord Howe, who is an expert in these matters, might talk more about music, since I am going to talk more about the visual arts. We have all known for a long time and research has demonstrated all too clearly that the environment has an important role in promoting healing. So important is it that RIBA, whose emphasis is architectural, has been keenly interested in all this. Indeed, at about the same time as the King’s Fund was developing its Enhancing the Healing Environment programme, with which I was closely involved, the RIBA healthcare client forum was running a percentage for the arts campaign for new NHS buildings. Sadly it did not become policy, but the current president of RIBA, Sunand Prasad, is very supportive of such programmes and things might change, particularly if we have a little political leadership around all this.
He recognises, as most of us should, that the environment can be as powerful a part of people’s treatment and care as the medicines, the therapy or the competence and compassion of the professional. Therapeutic environments have a demonstrable effect on health outcomes for patients and promote well-being among staff, and even more importantly, in a cash-strapped NHS where recruitment is expensive, they help to retain staff, who love working in better environments, as we all do.
Enhancing the Healing Environment aims to enable nurse-led teams to work in partnership with service users to improve the environment in which they deliver care; so it is absolutely key to a patient-led NHS. It consists of two elements: a development programme for a clinically-led, multidisciplinary team, including service users, and a grant for them to undertake a project to improve the healthcare environment. We started off with £35,000 grant to each of London’s main hospitals to celebrate the millennium—not a lot of money in these terms—and it simply expanded from there. This is no coincidence, because people all around us can see that it matters. Thus far, 130 teams from 119 NHS trusts, two hospices and five prisons across England have joined the programme. Independent evaluations have shown that the projects humanise the hospital environment and make places and spaces that are truly uplifting. This positive impact can be conclusively demonstrated not only in terms of participants’ perceptions but also in nationally recognised environmental scoring systems.
But there are significant longer-term benefits. First, there is far greater increased ownership of the hospital environment and a greater awareness of its impact on service users—patients, relatives and staff—and the wider public. Secondly, these small-scale projects can act as catalysts for major change and extraordinary transformations take place. I shall tell the Committee about one of them: as a result, I shall probably scrap the rest of the speech. Hillingdon Hospital in west London is in an area not well known for its calm Friday and Saturday evenings in accident and emergency. It was given £35,000, which was used to lever a further huge amount of money from the local community, from bits of the NHS and from charitable funds. It is absolutely right to say that little bits of charitable funding have mostly made the difference. The hospital transformed a horrible accident and emergency reception area, which had bullet-proof glass in front of the reception staff, into a beach. Members of the Committee may not think that this is a likely scenario. There is a huge palm tree in the middle, with small tables and deck chairs. The bullet-proof glass has been removed. The staff sit at low tables and people talk to them directly.
There has been no damage at all to this A&E department. No chairs have been thrown around or cups of coffee thrown at the staff, other patients or relatives. The only damage was to the palm tree. So beloved was it that it was over-watered and had to be replaced with an artificial one. To give true community ownership of this project, trees were put in with clay leaves and any member of the local community who wished to sign one of these leaves was invited to do so. It is a community arts project, which has transformed the atmosphere.
Having seen it with my own eyes; having seen what the noble Lord, Lord Mawson, has achieved in Bromley by Bow; and having seen what has been done at Northwick Park Hospital in the St Mark’s Hospital corridor where originally there was going to be a series of photographs of patients’ bottoms, but the hospital thought better of it—only the history of St Mark’s Hospital is now told in the photographs—I have no doubt of the transformational effect of changing the environment for staff, relatives and patients, some of whom come again and again.
We know that in mental health and dementia care the arts have made a huge difference. The Government are producing a dementia care strategy and I would love to know how the arts and health element is to be incorporated into that. However, we need to ask the Government some questions. The publication of that report was two years ago, and that is a long time. It recommended that we should recognise that arts in health are integral to health, to healthcare provision and to healthcare environments. The arts can also support staff. First, where is a clear political statement to that effect? Secondly, the report stated that arts and health initiatives are delivering real and measurable benefits across a wide range of priority areas for health, and can enable the department and the NHS to contribute to key wider government initiatives. Where can we see further evidence of that from government?
Thirdly, the Department of Health has an important leadership role to play in creating an environment in which arts and health can prosper by promoting, developing and supporting arts and health. But where is the new announcement backing this review? Where is the extra funding and where is the real commitment to making this central to how the NHS thinks? Will the Department of Health support the enhancing the healing environment network so that it can expand with anyone who has been on the programme and beyond and influence the NHS more widely?
Fourthly, where is a clear statement from the Department of Health on the value of arts in health and evidence of the building of partnerships with others involved, or even a prospectus for arts in health in collaboration with other key contributors, beyond what has been done already with the Arts Council? Finally, if the Government think that this is as important as we clearly all do, the principles behind enhancing the healing environment should be integral to all future NHS and Department of Health policy. It should be key for the NHS estate, with providers and commissioners taking it seriously. That, to my mind, means getting the healthcare regulators to set clear standards about the creation and maintenance of therapeutic environments. I very much hope that the Minister can give us some positive news on how some of that might now be taken forward.
What a fascinating subject this is. It was not until I started researching it during the past couple of weeks that I realised what a wealth of material there is about it. At the same time I came to appreciate the contribution that the Department of Health has made to putting these issues more on to the map. It was noble Lord, Lord Crisp, when he was chief executive of the NHS, who had the vision to ask the excellent Harry Cayton to carry out a review of arts and health and the role that the department should play in promoting these sorts of initiatives. As we have heard, that gave rise soon afterwards to the publication last July of A Prospectus for Arts and Health which in many ways should be seen as our base document for reference and policy purposes.
For many years the problem with anyone making the causal link between works of art and faster recovery times, or music and mental well-being, was that the evidence was in part anecdotal and in part hidden, and there was no properly joined-up approach to the subject across the health service. Yet the knowledge was there. The striking part was that once Harry Cayton had asked the question, he was inundated with replies not just from the NHS, but from representatives of every conceivable discipline in the field. These were detailed submissions of a kind that enabled the working group to conclude unequivocally that the arts are,
“integral to health, healthcare provision and healthcare environments”—
note the word “integral”—and that, as the noble Baroness has just quoted,
“arts and health initiatives are delivering real and measurable benefits across a wide range of priority areas for health”—
again, note the words “real” and “measurable”.
What are those benefits? Many have been referred to by other speakers, few more graphically than by the noble Lord, Lord Mawson, and the noble Baroness. I was certainly aware of the role of the creative arts in mental healthcare in enhancing patients’ self-esteem and reducing their feelings of isolation, both of which are absolutely crucial to recovery. What I had not previously seen were the research findings about music, that listening to music has been shown to have a beneficial effect on anxiety, heart rate, blood pressure, immune response and even the perception of pain. Rheumatoid arthritis sufferers who listened to 20 minutes of music every day were in less pain than their fellow patients who did not. That is pretty dramatic stuff, though when it comes to music we first need to establish with the patient what kind of music might best do the job. To inflict hard rock on someone who specialises in string quartets might well have the opposite effect from that intended. In fact, it might be a rather devilish way to murder someone.
The benefits that the working group identified are not only for the patient. At the Chelsea and Westminster Hospital it was found that patients’ length of stay on trauma and orthopaedic wards was shorter when they were exposed to visual arts and live music, and that their need for pain relief was significantly reduced. The same kind of results were found in quite separate studies by the University of Nottingham and the University of Sheffield. If the arts can actually reduce the cost of treating patients, that surely is the argument that should, par excellence, persuade trust boards to invest in them. The Sheffield study came up with compelling evidence about the feel-good factor created by new hospitals. It compared an old hospital with a new one. In the new mental health unit there was a marked drop in injury and in verbal and physical abuse compared with the levels experienced in the old unit. The King’s Fund, as has been said, has done some remarkable work showing how improvements to the working environment can deliver significant improvements to clinical practice, safety, team working and staff retention.
There is little doubt that good hospital design can reduce the cost of care in that sense, but there is another important dimension to this as well. The therapeutic benefits that mental health patients derive from the creative arts are not just a matter of delivering a feel-good effect; they extend wider than that. Last September, Manchester Metropolitan University published a fascinating study called Towards Transformation: Exploring the Impact of Culture, Creativity and The Arts on Health and Wellbeing. The key point that it makes is that artistic activities, such as painting, singing, gardening or dancing, enhance people’s sense of self-esteem, not only in mental health but across the board. It is that enhancement of self-esteem that affects a person’s sense of purpose about life in general, which in turn creates in them a desire to take control, to change and to make healthier choices. Artistic activity can bring about a more balanced perspective on life, thereby enabling people to move away from dependence on healthcare and much more towards self-reliance. We think immediately of Derek Wanless’s fully engaged scenario, and the arts should be seen as one important catalyst for delivering that scenario.
The evidence is there, and Ministers have made their own contribution by publicly endorsing the prospectus. The challenge is now, as I think every speaker has said, how to deliver. How are we to get these evident benefits embedded as a standard part of the healing process? To a large extent the answer depends on building capacity in the system, and the voluntary sector is surely going to be key to that. I understand that the department has recently issued a consultative document about DH funding of third sector organisations. It would be helpful if the Minister could say whether this particular area of commissioning is being explicitly considered as part of the consultation. PCTs need to see that creating these sorts of partnerships is important, not least when it comes to those communities that are relatively disadvantaged and where there is little infrastructure on the ground. Perhaps we can expect foundation trusts to lead the way on that kind of initiative, but elsewhere in the NHS the department needs to play a role. It would be useful to hear from the Minister how the plans set out in the prospectus are being followed up on the ground.
The other key ingredient of success is surely to get arts and health on to the regional and local arts agenda in a systematic way. I have to say—this is the only faintly sour note I am going to strike—that the recent cuts in the Arts Council budget are likely to make progress in this area very much more difficult. Two hundred and twelve organisations are going to see their regular funding cut or withdrawn, and within that are organisations that support links between the arts and healthcare—such as, to give but one example, the Salamanda Tandem Dance Company, which specialises in training for dance work with autistic children. To make matters worse, we are all aware of how the National Lottery has been raided for various ends, some more worthy than others. The result is that the amounts of lottery funding for the arts were over £100 million less last year than they were 10 years ago.
It is disappointing, to say the least, for Mr Lammy, the DCMS Minister, to have put his name to the prospectus last July directly endorsing all the benefits of the arts and health, and almost simultaneously to be undermining many of those initiatives. I am not just making a political point. The success of any policy is measured in part by its sustainability. In the past, a lot of funding for arts and health has been short-term, assuming you could secure it at all. I hope that we will hear from the Minister not only a commitment to arts and health as a dimension of health policy but also some clear undertakings about how in practice the policy is to be delivered over the medium term, how it will be taken up more widely and embedded in NHS commissioning processes and what role the department will take in helping commissioners and providers to win over hearts and minds and to build capacity in this important but still largely unsung area.
I congratulate my noble friend Lord Howarth on raising this important topic for today’s debate. He has an unrivalled record of work in this area, not only when he was Minister for the arts, but since, when he has been cajoling Ministers and pushing the Government to keep the importance of arts in healthcare on the agenda and ensure that action is taken. It has been fascinating to listen to the debate and, as a new Minister, a rewarding experience to learn about a new subject, although in fact I have been long familiar with some of the work that has been mentioned.
As most noble Lords have said, linking the arts with health is not a new, untested or fringe activity. It has long been recognised that art has the potential to deliver more robust outcomes and improvements for patients, users and staff—in fact, the whole of our health service. Florence Nightingale herself said in her 1859 Notes on Nursing that:
“The effects of beautiful objects, of variety of objects and especially of brilliance of colour is hardly at all appreciated … People say the effect is only on the mind. It is no such thing. The effect is on the body, too. Little as we know about the way in which we are affected by form, by colour, and light, we do know this, that they have an actual physical effect. Variety of form and brilliancy of colour in the objects presented to patients are actual means of recovery”.
Bearing these words in mind, we should recognise what has been achieved by the many arts and health organisations and initiatives that have been established in the UK over the decades, many of which have been mentioned by noble Lords in the debate.
Indeed as the noble Earl pointed out, the Department of Health itself has provided leadership and guidance to the NHS and has for many years encouraged the use of the arts as integral to health and well-being. And I agree that of course it is not just about paintings on walls, whether they are of bottoms or of historical events. The concept of art for health encompasses literature and writing, theatre and drama, dance, music and many forms of visual arts. None of this would be possible without working alongside many charitable and voluntary organisations which rightly deserve praise for their enthusiasm in embracing the arts as an integral part of healthcare. Numerous fine examples have been cited, and perhaps I could mention a few.
At St Bartholomew’s Hospital we have seen how the recent development of the Bart’s and The London Breast Care Centre has integrated art into the overall design of the facility from the outset, with the aim of improving the whole patient experience. I personally have been a supporter since 1994 of the Theodora Children’s Trust, which has brought laughter, fun and magic to hospitalised children in the UK. The clown doctors, who are specially trained to work in the hospital environment, are a welcome distraction from the often difficult situations that children and their families face in hospital, and their regular visits can have a positive impact on children’s recovery and rehabilitation.
“Singing for the Brain” is a group activity started and managed by the Alzheimer’s Society West Berkshire branch for all people with memory problems and their carers. It is an opportunity for them to participate in singing sessions together in an informal and friendly setting. The aim is to provide an enjoyable activity that stimulates the mind and body. The happy and sociable atmosphere offers the opportunity to make friends and to help each other. These and the many other examples mentioned by noble Lords demonstrate the range and diversity of projects that are proving highly successful. I believe, as a social entrepreneur, along with the noble Lord, Lord Mawson, that one of the reasons for this diversity is because the voluntary and third sectors are so active in this area.
I turn now to our commitment that the arts should be firmly recognised as integral to health and healthcare. In 2006, as has been mentioned, the department commissioned a review of arts and health that was followed in 2007 by the publication of A Prospectus for Arts and Health produced jointly with Arts Council England. That document sets out the department’s policy and commitment to collaborate across government in promoting, developing and supporting arts and health, as already outlined by my noble friend Lord Howarth and other noble Lords. More recently, the Government, along with Arts Council England, have worked closely together to promote the benefits of dancing for health. Through its obesity strategy programme, the department is continuing to explore what more can be done to maximise the health benefits of dance.
On mental health, the department’s National Social Inclusion Programme is engaged in a range of arts-related initiatives, including working with community arts projects and national arts organisations, and promoting skills in developing the future evidence base on arts participation.
In addition to working on cross-government initiatives, the department has for several years contributed significantly to the King’s Fund’s Enhancing the Healing Environment programme, which has more than 100 participating schemes, so ably described by the noble Baroness, Lady Neuberger. By transforming environments and including art, these schemes have demonstrated therapeutic benefits, reduced staff and patient stress, supported staff development and improved the retention and recruitment of staff, as the noble Lord, Lord Mawson, said. The department has recently funded a scoping study to ascertain the viability of mainstreaming this programme across mental health and learning disability services. In addition, the initiative has recently been extended to the Environments for Care at End of Life programme, to which the department is contributing £1 million of funding.
I now turn to the sometimes contentious issue of spending on the arts for health, which noble Lords have not mentioned today but which has occasionally been a topic for often misinformed discussion among our friends in the media. I want to make it clear that we are unashamed about the need for, and our commitment to, spending on the arts for health. It is a legitimate investment for the NHS, and we welcome the fact that many arts projects are often funded locally through charitable trusts and donations. Much of the work of the sector has grown through the work of many committed individuals and voluntary and charitable organisations. As my noble friend Lord Howarth has said, there are calls for further central funding, and it is clear that additional money would always be welcomed. We believe that tackling issues about awareness, evidence and understanding are an effective way to increase investment, and that it is in keeping with creating a patient-led NHS. Local communities know best how to use the arts in their own work.
On the specific questions asked by noble Lords, my noble friend Lord Howarth and the noble Earl, Lord Howe, talked about the evidence base, and although some pieces of evidence are less rigorous than others, the Government completely agree with noble Lords that there is enough evidence to demonstrate the benefits clearly. On the question of funding and the request for £50 million, I could not possibly comment on any figures, but we recognise that arts co-ordinators are key appointments. However, as noble Lords will know and as the noble Earl said, PCTs are now in control of 82 per cent of the NHS budget, and the direction of travel is that a lot of that funding needs to be found at a local level. Indeed, PCTs know how best to invest in their own work. I hope that many of the organisations that we have mentioned will press them to make that investment.
The noble Baroness, Lady Sharp of Guildford, as ever eloquently raises the issues dear to her heart and about which she is so well informed. I will ensure that the appropriate remarks are passed on to my noble friend Lady Morgan, who may give her more satisfactory answers than I can about the financial details, although of course I agree with her that the arts have a huge role to play in the health and well-being of older people, and I recognise the need and enthusiasm for learning a range of skills right through one’s life.
I feel I should put on record the fact that the noble Lord, Lord Mawson, and I are fellow Bradfordians. We are also fellow supporters of social enterprise. I have visited the Bromley by Bow Centre several times and for many years, and I can say no more than anyone else about how impressive and wonderful that project is. It is always inspiring and deserves replication, perhaps of the sort described by the noble Lord. His description of the work of the centre is completely correct, and I will ensure that his words are drawn to the attention of my noble friend Lord Darzi. If it is not being considered by my noble friend’s review, I will ensure that it and the noble Lord’s remarks about the polyclinics in particular are brought to his attention.
The noble Baroness, Lady Neuberger, described with her usual passion and huge knowledge the important work of the King’s Fund, the RIBA and others. I very much enjoyed her description of Hillingdon Hospital. The department is undertaking a major scoping study to mainstream Enhancing the Healing Environment, as I have mentioned. The Minister, Ivan Lewis, spoke in November last year, at the King’s Fund conference on sharing success, about how to roll this out.
The department will work with the new regulator. It is always striving to raise the profile of the built environment and stressing the vital role that it has to play in healthcare. Clearly, it has to be part of the work of the new regulator. I am sure that the noble Baroness will be raising such issues during the passage of the Bill that is coming our way.
It is important to pay tribute to one or two arts organisations in particular that have worked tirelessly for many years to improve the quality of life for those involved. There is Painting in Hospitals, a charity established in 1959, Arts for Health, established in 1988 and, perhaps most significantly, Music in Hospitals, which is celebrating its 60th anniversary.
I thank all noble Lords who have taken part in the debate. The lack of a recent political statement does not mean that work is not being done. I hope that my remarks have assured noble Lords of the Government’s commitment in this area. However, I will get in touch with my right honourable friend the Secretary of State and suggest that he should mention this in a forthcoming speech. I assure noble Lords that we will continue our work across government departments and with other agencies to ensure that the arts make a major contribution to people’s health and their lives in general.