First Reflections on the ‘10 Year Plan’: Opportunities for Creative Health

Patients will be assigned a ‘personalised health budget,’ giving them more choice over their own care. This presents an opportunity for patients to choose non-clinical alternatives to support their health and wellbeing. Health promotion campaigns that focus on the value of the arts on health will become increasingly important to enable autonomy and informed choice, with more patients ultimately engaging with Creative Health offers.

 

Accompanying the budget will be an NHS app, which will provide comprehensive access to local service offers. To be inclusive, this app should include Creative Health practitioners, Creative Health link workers, and Creative Health knowledge resources. It is important that the field of Creative Health unites to ensure this inclusion. Our presence in existing infrastructure navigation apps, such as Joy will be an enabler in this journey.

 

Additionally, there will be the creation of Neighbourhood Health Centres (NHC), which house multi-disciplinary teams (MDTs). I think this is an extremely exciting development in the NHS, allowing members of the public to access support from a range of specialists – not just GPs or pharmacists – close to home, and making service navigation far easier – reducing incompatible demand on GPs and increasing access to specialist alternatives, such as Creative Health. Whilst some Creative Health advocates, such as GP Amal Lad - leader of the Midlands Special Interest group in Creative Health – have seen the potential of Creative Health within MDTs, it will be more important now than ever for our field to advocate for our inclusion, via Creative Health advisors/ link workers. Moreover, NHCs present opportunities for Creative Health sessions to be offered within NHC buildings, and for posters about Creative Health benefits being visible on its walls.

 

The plan will see investment of up to £120 million to develop more dedicated mental health emergency departments. Since Mental Health services make up a large portion of Creative Health offers, there is an opportunity to train Emergency Mental Health staff in Creative Health literacy, so that they can recommend follow-up support to their patients.​

 

From analogue to digital: power in your hands

 

Building upon the plan’s language of ‘doctor in their pocket,’ our advocacy efforts can push for a paralleled ‘Creative Health advisor in their pocket’ – recognising the benefits of improving public access to Creative Health knowledge specialists, and helping trained Creative Health professionals, coming from programmes such as UCL’s Masters in Creative Health, to contribute meaningfully to the economy.

 

The introduction of a Single Patient Record (SPR) is said to ‘enable more co-ordinated, personalised and predictive care’. The SPR presents the opportunity for Creative Health providers to measure attendance at their groups and track their influence over health outcomes. This would support a current barrier in Creative Health, regarding evidencing clinical/ preventative outcomes. Moreover, if scannable entry is enabled in the app (e.g., via QR codes), services can minimise difficulties in data collection – freeing them up to deliver fun, creative, and health-promoting services.

 

The plan will see the scaling up of personalised care approaches via preferred providers – where patients choose appropriate services for them based on attraction and compatibility, rather than commissioners dictating preferred providers based on systems bias. In this context, Creative Health has the opportunity to amplify its impact in prevention and be seen by a new audience of health users. This aligns to the government’s push towards ‘cross-societal energy on prevention’.

 

Members of the public will also be invited to feedback on care, influencing how services get paid and which services patients choose to engage with in the future. This is an unparalleled opportunity for Creative Health leaders to collect data on how Creative Health impacts our participants.  

 

The digital infrastructure outlined in this plan will enable continuous monitoring of patients’ health, allowing clinicians to reach out to individuals at pertinent moments. Where appropriate to their specialisms, it will be interesting to see if there is a future where Creative Health providers gain access to this monitoring system, so that they can make their services known to at-risk users.

 

With the introduction of ‘HealthStore’ – a place where patients can access approved digital tools – we should celebrate the achievement of Immersive Arts more loudly, particularly those that use biofeedback and other AI technology, as these are highlighted as areas that the government want the health system to be recognised internationally.

 

From sickness to prevention: power to make the healthy choice

 

Children and Young People’s (CYP) obesity has been identified as a healthcare priority. We know that play – one of the key components of many Creative Health services – is a particularly important method for engaging children in fun and healthy eating, influencing their long-term health behaviours. Moreover, dance and other creative movement activities are an incentivised route to physical health and weight management – accessible to both children and their families. Creative outputs – such as theatre, animations, and creative social media content – are essential tools in CYP-focused health promotion content. Research such as Talent25 – a 25-year longitudinal study tracing the long-term health and wellbeing impacts of babies and children engaging with the arts – also supports the understanding of Creative Health as a contributing social determinant of health, akin to the government’s Healthy Start food and milk programme. Additionally, Creative Health co-production methods are already being used, to great success, to include CYP voice and increase the impact of non-Creative Health incentives.

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This work-stream will be commissioned on a ‘pay for impact on health basis,’ which may present a fairer way for Creative Health to be recognised and compensated for their health outcomes.

 

The plan’s health reward scheme aims to incentivise members of the public to engage in healthier behaviours. By shouting about the joyful health-promoting benefits of Creative Health services, we have an opportunity to turn incentivised participation into long-term engagement and healthy behaviours.

 

Another area of focus is to help people find and stay in work – a key determinant of long-term health and wellbeing. Award-winning Creative Health case studies, such as HQ Can CIC demonstrate the impact that Creative Health has had on CYP employment, confidence building and civil engagement.

 

Adding to this, CYP mental health is a featured priority. The field of Creative Health offers a more personable approach to mental health compared to traditional providers. Our services encourage a sense of autonomy over life narratives and have been shown to develop resilience, identity, self-worth, and interpersonal communication.

 

A developed and diverse NHS: a new operating model

 

A practical element of the plan which affects NHS Trusts, is their ability to retain surpluses and reinvest them. This will support more informed, long-term decision making, allowing more co-production to take place with creative practitioners and members of the public when innovating person-centred services. It is also a strong motivation for the cost-saving opportunities of Creative Health led care (i.e., when our services save the health system money, the savings can more readily be reinvested in test-and-learn pilots for pioneering Creative Health provisions) – balancing evidence-led care and innovation. A great model for this comes from Gloucestershire ICB whose Breathe In Sing Out programme has the second highest impact on respiratory conditions, out of all their respiratory programmes, yet holds one of the smallest price tags.

 

Another incentive featured in the plan is having pay tied to performance. If this is extended to NHS commissioned services, not just PAYE staff, then Creative Health providers may be afforded an opportunity to have our long-underfunded services valued for their impact and compensated more fairly. The possibilities of Creative Health’s impact are multiplied when resources are not stretched, and more time can be dedicated to delivery.

 

The plan states that work with private suppliers will enable the expansion of NHS provision in the most deprived areas. Health inequalities is a key concern for the Creative Health movement as a whole. We connect to populations in ways that health leaders struggle and provide creative alternatives for staying healthy and well. As private suppliers, ourselves, we have much to offer to the most deprived areas. Creative practitioners hoping to engage in this space benefit from healthcare partnerships to understand need and to align the communication of their service to this articulation of need.

 

A new transparency and quality of care

 

Patients’ choice of services/providers will be informed by length of wait, patient ratings, and clinical outcomes, all of which will be searchable on the NHS app. In community-based Creative Health work, we excel in getting to groups quickly when they want our support, due to industry cultures of adaptation and mobilisation. If we can continue the strengths of our independence, whilst serving Integrated Care goals and receiving appropriate recompense, we are well placed to perform strongly on waiting time metrics. People who engage in Creative Health provisions typically engage more consistently than traditional options, and continue to access creative provisions independently following short-term NHS-funded programmes, signalling high-performance in patient experience. Clinical outcome measures will need to be more appropriately tracked. The NHS app will help creative providers to collect data they have struggled to previously.

 

An NHS workforce, fit for the future

 

Each member of staff will have a personalised career development plan, helping them to acquire new skills. It would be good to see if training options in Creative Health will be made possible, enabling health professionals to understand and implement best practice in Creative Health delivery. Such training programmes are already in development, enabling health professionals from different backgrounds to understand how Creative Health can support their professional context and practice.

 

There is also an ambition to reduce NHS sickness rates. A large portion of NHS sickness is due to mental ill-health (e.g., stress, moral injury, bereavement of staff who have committed suicide). Creative Health in hospitals supports the mental health of the workforce (see here for a Roundtable discussion on Workforce Wellbeing led by the National Centre for Creative Health, in partnership with UH Derby and Burton NHS Foundation Trust, and here for a National Arts in Hospitals Guidance resource, from the National Arts in Hospitals Network).

 

There is also going to be an increased number of nurse consultants and 2,000 more nursing apprenticeships over the next three years. Nursing is a context in which we have seen Creative Health flourish. For more information, see Marion Lynch’s Art of Nursing Webinars or read about Creative Health in nursing training.

 

The movement to incentivised working styles for quality assurance brings with it a more privatised style of working, where good activity leads to monetary gain. If you are interested in thinking about the economics of Creative Health more broadly, consider checking out my book A Creative Health Communication Framework, which has chapters dedicated to this.

 

Productivity and a new financial foundation

 

According to the report, 38% of public funding goes to the NHS, with expectations of 40% by 2029. This 38% does not align to the 10-20% proportional impact that clinical services have on health outcomes. The plan’s movement away from hospital and towards communities signals a changing in mindset for how we fund health and wellbeing. This presents an opportunity to advocate for more public funding towards Culture and Heritage, with ringfenced portions of this dedicated to health promoting provisions. This would allow the Culture and Heritage industries to maintain their independence and industry cultures, whilst being appropriately funded for the portion of health and wellbeing they contribute towards as a social determinant of health. Greater governmental consideration of opportunities like this, will support their ambition to limit NHS funding whilst promoting better health outcomes.

 

Additionally, the report states that ‘care in the community is cheaper and more effective than care in hospitals’. The more that Creative Health providers can demonstrate the value for money of their services, via comparable outcome measures, the greater our voices will be heard within the sea of community providers. Moreover, Creative Health practitioners already excel in bringing community approaches into hospitals. For example, through hospital arts we improve outcomes for patients who require a hospital environment.

 

Digitalisation has been prioritised to enable more productivity for lower cost. There is an opportunity here for us to develop digital art platforms to address accessibility and long-term cost of engagement for people with complex access needs. (This comes with a note of caution: there is a need to research the effect of digitalisation. For example, research suggests that VR access to museums does not lead to the same bio-outputs as going in-person, despite participants self-reporting benefits).

 

Finally, there is a push to end block contracts. Instead, service commissioning will be based on attendance by patients, outcomes, and patient feedback. It will be important for Creative Health providers to ensure sufficient attendance, which is properly recorded, for funding to be secured. This can be complex to navigate in an arts context, demonstrating the value in more joined up referral systems.

 

Final thoughts…

 

These reflections are my initial impressions of the Executive Summary of the 10-Year Plan. As we all find time to digest the longer messages of this text and consider possibilities, there will be much more room for discussion and insights. I hope that by outlining my thoughts on this page, I can contribute to initiating some of those valuable discussions.