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monthly reflection on current Lapidus-related issues

July

measuring and making choices

Arts in Healthcare projects work hard to justify themselves. Organisers, artists, facilitators, writers in residence come to the work passionate about and skilled in working with people and their health challenges, but they rarely take their role within healthcare settings for granted. They endeavour to find accurate words to describe the work, they evaluate carefully, they compile feedback from participants, they use existing evaluation tools used in medical environments (such as the General Health Questionnaire or Improving Access to Psychological Therapies - IAPT), they design additional methods of showing how the work is valuable.

Some healthcare providers are funding arts in healthcare projects, in particular art and music therapies. Story, narrative and writing projects also receive some direct funding. Often such projects are sustained by arts and charitable sources. It might be assumed that in the harsh economic climate, such activities will, like everything else - and even more so - be subject to cuts. The UK government is looking for billions of pounds of cuts to National Health Service budgets and is intending to reorganise commissioning of health services, which will cost billions, with the idea that this will reduce waste and make providers more careful about choosing cost-effective treatments. Whatever one's interpretation of the politics of this and the likely outcomes for patients and providers, no one can doubt that enormous change is underway.

Simultaneously, healthcare environments are changing - physically, culturally. The 'big story' is that everything has to be cut. The sub-plot tells us that some cost-effective elements of healthcare might be essential to see us through the stresses and strains of this upheaval. There is a growing recognition that effective healthcare involves 'environment' in a broad sense: from bricks and mortar outwards, changing cultures are altering the spaces where people meet, talk and receive treatment.

'Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity' said the World Health Organisation just after the seismic upheavals of the 1940s. Polarities between providers and patients are changing too as it is understood more consciously that healthcare environments affect both. If the building is falling apart, airless, depressing or ill-equipped, all suffer, including staff. If it contains rooms for effective treatment, and space for humans to negotiate the difficult business of illness in a variety of ways, if it has views through windows, changing artwork on the walls and a sense that immediate treatment is one part of a longer-term whole, it is likely to succeed better in its aims. It is likely to retain staff, who will have fewer days off through sickness. It is likely to enable patients to find resources in addition to medical treatment.

The spacious green gardened Dartington Hall in Devon was the setting this month for the 'Reach Learning Event', where four inspiring arts in healthcare projects were presented and discussed. These projects had been run with funding of £100k from the Arts Council and matched funding and involved parterships between artists and health organisations. Whilst the funding was more than the vast majority of arts in healthcare projects cost, this was because they set something of a 'gold standard' of organisation, support and partnership establishment. The outcomes included the learning opportunities for others in the future.

In Dorset, one of the four regions covered, Bridport Arts Centre, Bridport Medical Centre and Dorset Primary Care Trust collaborated on a project that delivered Creative Writing and Art sessions to patients via their GP surgery. Aims of the project included to 'increase the options available to the GP service in Bridport in providing for those with minor mental health problems, contributing to reducing reliance on the primary care team and reduced prescription costs' and to 'increase participants' confidence, skills and interests and raise awareness of the benefits of nature in tackling depression while providing evidence for increased use of creative activities within primary care'. Participants attended workshops where they 'explored nature along the Jurassic coast through walks, photographs, drawings and poetry'. This project incorporated multi-strand evaluation: IAPT data, artists' own notes, participants' artwork and writing, external evaluation linked to National Institute for Clinical Excellence's guidelines. In front of delegates at the conference were stunning slides of participants' artwork and writing. The 'tree of life' was a theme that permeated the project and found diverse forms.

Discussions and questions at the event turned over many familiar worries about how such projects can provide 'evidence' that they are valuable. Unfortunately, there were far fewer representatives of healthcare providers in the room than artists. But an informed specialist in nursing teaching pointed out that medical environments are now interested in a range of evaluative material - they too are changing, and much more open to the sorts of different evidence that the Reach event provided. At the same time, there is recognition that the social - and therefore health - impacts of economic stringency are going to require more, not less, attention, to the individual voice and individual stories, and to the development of people's personal resources to cope. When people's creativity is kindled, they are empowered. Long-term effects may be significant. Others are affected and transformations occur in unforseen ways.

See Arts in Health South West website for further details of the Reach Learning Event
© F Hamilton