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Jenni Regan

Foreword by London Arts and Health Director

Jenni Regan

This guide has been a year in the making and we at London Arts and Health are so excited to see these resources come to life as a downloadable guide, website, podcasts and video.

I want to thank the Culture and Creative Industries Unit, GLA, for starting the process and for all the incredible arts practitioners, medical and care staff and funders we have worked with to produce this.

Creative activity has long been known to have tangible effects on health and quality of life. The arts, creativity and the imagination are agents of wellness: they help keep the individual resilient, aid recovery and foster a flourishing society.
Arts in health programmes across the capital are using diverse and dynamic disciplines in a variety of health, care and community settings for expressive, restorative, educational and therapeutic purposes.

London faces one of the highest levels of health inequality in the world. With life spans of residents living just streets apart varying greatly. Covid-19 has highlighted and increased the divide in the health and wellbeing experienced in the city.

In our current political and economic climate, arts in health offer a professional, value-for-money contribution to mainstream health care as part of the social prescribing movement and yet we know that many of our members and the cultural practitioners across the Capital are struggling to get involved in the process.

This guide is designed to dispel some of the myths surrounding social prescribing in the arts and cultural sector. We recognise the importance of hyperlocal grassroots organisations in leading the London recovery and we aim to ensure a level playing field for all who offer culture and arts for health and wellbeing.

Introduction:

What is Arts and Cultural Prescribing?

Humans have long used arts as a way to make sense of the world, build connections and define themselves whilst benefiting from the arts’ therapeutic effects.

Many of us recognise that the arts and culture can make us feel better.

Social prescribing, in its simplest form, is a way to build on these ideas, through the active recommendation of arts and culture on prescription. But many people are not sure what social prescribing means, how it can benefit them, or how they might get involved in activities. Arts and culture on prescription, through NHS referral or self-referral can benefit everyone, from children to adults, older generations and families alike.

This simple guide aims to debunk some myths associated with social prescribing by providing straight-forward information for the individuals or arts cultural organisations looking to deliver social prescribing activities. We have also produced a podcast series, speaking to people involved in arts and cultural social prescribing across London.

Social prescribing and community-based support enables all local agencies to refer people to a ‘link worker’ to connect them into community-based support, building on what matters to the person as identified through shared decision making / personalised care and support planning, and making the most of community and informal support.
(NHS England Universal Personalised Care, p.21)

Across the UK, social prescribing is being used as a means of connecting people of all ages to activities designed to help enhance their mental health, wellbeing and reduce isolation in their day to day lives. Typically, social prescribing might be recommended for a patient in two main ways:

  • By healthcare staff working in a primary care setting, for example a GP or practice nurse.
  • By adult social care professionals working for a local authority.

Once referred, most patients then work with a local link worker to identify schemes together that might help them improve mental health, wellbeing or reduce isolation. These might include anything from support with housing or finances, sports and cooking, but increasingly, arts and cultural activities.

Social prescribing is described as something that is part of Universal Personalised Care, which is part of the NHS long term approach to health and social care in the UK. It gives people more agency in deciding what is best for them in relation to their health.

Social prescribing is delivered in many different ways across the UK, as individual local authorities are best placed to provide the most effective delivery solution. As a result, it is difficult to provide a single database of effective social prescribing arts and cultural activities, as each regional area has its own social needs, and different levels of arts and cultural provision.

There are many resources that can help you find out more about social prescribing in your area. The Healthy London Partnership have produced this YouTube video about social prescribing in London, and the Culture Health and Wellbeing Alliance (CHWA) curate this webpage about social prescribing. There is also regional support available through The Social Prescribing Network
Illustration of man singing with book

The NHS Long Term Plan aims to incorporate social prescribing into its comprehensive model of care.

This means that across the UK there is an increase in funding for activities such as arts and culture on prescription through the social prescribing model. At a practical level as the NHS rolls out its comprehensive model for personalised care across England, it will mean that 2.5 million people will have more choice and control over support for their mental and physical health. This will be achieved by ensuring that up to 200,000 people benefit from a personal health budget by 2023/24, so they can control their own care, improve their life experiences whilst achieving better value for money for the NHS. These people will be empowered to use the money provided to pay for social prescribing activities, including arts and culture on prescription. The model also supports putting in place more than:

1,000 Social Prescribing link workers and community connectors by the end of 2021, rising further by 2023/24, with the aim that more than 900,000 people are connected to wider community services that can help improve health and well-being.’ (NHS England, Universal Personalised Care).

But what does this mean for arts and cultural organisations? Although funding is not clear cut, many individuals or organisations can usually apply to their local authority for funding to help pilot or run social prescribing projects. Some have also been successful securing support from local healthcare partners, including Primary Care Networks and Clinical Commissioning Groups. Independent trusts and foundations, and National Lottery distributors Arts Council England, The National Lottery Community Fund, and the National Lottery Heritage Fund may all also be able to support certain delivery or partnership activities in the social prescribing space (check their websites to see which compatible funds are open). NHS Charities Together have also launched a Community Together Partnerships grant. It is worth thinking from the outset about how you will sustain a project long term, as many patients referred need long term arts and cultural interventions, rather than short-term, one-off projects.

In 2019, The National Academy for Social Prescribing was launched by the Secretary of State for Health and Social Care, the Rt Hon Matt Hancock MP. Last autumn, the Academy announced its Thriving Communities programme to unleash the power of social prescribing. Thriving Communities is a support programme for voluntary, community, faith and social enterprise groups who are supporting communities impacted by COVID19 in England and working alongside social prescribing link workers, to share their learning, gain new ideas and develop partnerships across sectors. It is supported by the Thriving Communities Fund (administered by the Arts Council), which seeks to improve and increase social prescribing community activities. The Arts Council is currently administering the Thriving Communities Fund on behalf of the National Academy for Social Prescribing and other partners including Natural England, Historic England and Sport England.

Illustration of mosaic

Link workers, sometimes called community health workers, are the go-to point people for social prescribing referrals.

Some link workers are based at GP surgeries, whilst others may work across a range of community settings, charities, as well as voluntary settings. The NHS sees link workers as pivotal as part of its national rollout of social prescribing. Primary Care Networks (PCNs) provide a coordinated group of GP surgeries which act as a conduit for most link workers. This approach enables PCNs to be reimbursed for the cost of a link worker if they serve (as a group), a population of 30,000 or more. In autumn 2020, the NHS reported that more than 1,200 link workers were in post. Results like this help the process, the continued growth of the scheme generating more demand for a greater range of arts and cultural projects to refer patients to.

In London more link workers are being recruited than ever before, with around 350 link workers in post across the capital. London link worker training happens at the Bromley by Bow medical centre, the specialist organisation who is the lead in the capital for this kind of training. Link workers act as a broker between GPs or local authorities who made the referral, and the organisations that patients may be referred to. It's their job to have local knowledge of relevant charities, sports, arts, community & cultural organisations, groups and support that can be offered to a patient. Link workers stay in touch with a patient, and sometimes evaluate how well that person is doing through their participation in their social prescription. They can also refer a patient back to their GP, if they need a more medicalised intervention.

Paper cutout figures

As with any new scheme, measuring the impact of social prescribing has been varied.

Building clinical and arts-based evidence is vital to secure funding and support the continued growth of the scheme. The NHS recommends following the Common Outcomes Framework as a clear starting point for how to approach evaluation of social prescribing projects. An academic study by the University of Westminster showed that many outcomes could be recorded more effectively in social prescribing evaluations. Simply put; this means that many brilliant examples of social prescribing in arts and culture are not being captured and highlighted for others to build upon.

Setting up good evaluation of your project means that tangible health and wellbeing outcomes can be measured, showcasing how well your project is working and contributing to the overall evidence base for the scheme. Developing your social prescribing work using the Quality Assurance for Social Prescribing framework will help you consider what project protocols you might need to have in place. This could range from measurement and evaluation processes to data compliance and mental health training.

Sometimes, the thought of developing a project evaluation can feel overwhelming and confusing. A good place to start is to examine other arts and cultural organisations approaches to evaluation and build on already and effectively used scales of health and wellbeing in relation to arts and culture. Creative and Credible have produced a very clear guide to how to approach evaluation within an arts and health context.

Dr. Daisy Fancourt provides a clear approach to research and evaluation in her (2017) book Arts in Health: Designing and Researching Interventions. Westminster University details approaches to evaluation in their work about social prescribing. Arts for health and wellbeing: an evaluation framework was developed by AESOP and Public Health England, and provides a clear framework in which to approach evaluation and implement findings. Ultimately find what works for you, your funders and your participants. Over-evaluating and surveying participants also may not help them in their recovery, so think about who you might partner with to approach evaluation in a creative and sensitive way.

Illustration of potter

Many arts in health practitioners have been working for many years, as freelance practitioners.

They sense that their practice has therapeutic, health and wellbeing effects for participants, and may have regular clients or run small weekly groups engaging the local community in arts practices. It can therefore feel confusing and overwhelming to begin to engage with the social prescribing infrastructure, as a lone practitioner. But it is possible. In London there are also opportunities to enrich your practice in relation to social prescribing through training, such as provided by Performing Medicine. There are clear steps you can put in place if you believe your practice could help someone being referred for social prescribing.

Step 1:

People being referred into social prescribing may have many complex psychological, social and economic needs. Firstly, consider if your practice is set up in an optimal way to support someone who might have these kinds of needs. Think about any adjustments you might need to make, for example securing additional funding to offer longer-term arts courses or brushing up on your evaluation skills. Training such as the Performing Medicine social prescribing course, or the CHWA Culture, Health and Wellbeing online course can help to strengthen your skills.

Step 2:

Social prescribing works better when we all work together. Contact your local arts and culture organisations and offer to collaborate on funding bids. You will have expertise that an organisation might lack, they might have space and resources that you do not have access to. Utilise free tools like London Arts and Health's Partner Up website to find people to collaborate with.

Step 3:

Contact your local community GP or PCN and request to find out who the link worker might be. Make them aware of the kinds of arts in health practice you offer and how someone might be referred. Make sure you make it clear how you might be able to offer support for any referred patients through your practice. Provide the link worker with leaflets or a link to a website so referees can access information about what you offer.

Illustration of embroidery

Many arts and cultural organisations are already set up to engage with social prescribing.

This might be through existing activities that are on offer, or through the use of rehearsal or studio space that can be used by a local community arts in health freelancer. Encouraging the take up of arts in health activities through social prescribing in your organisation will widen the reach and diversity of audiences and help people to think differently about what arts and cultural organisations/venues can offer. We recommend following these three steps if you think your arts and cultural organisation is ready to be more actively involved in social prescribing.

Step 1:

Think about what provision you already have in place that might have arts in health benefits for people being referred through the scheme. Is there a project, group or class already running that might already be beneficial to the scheme you can rebrand with a health and wellbeing efficacy? To get started, why not look at this systematic review of 86 culture, health and wellbeing schemes.

Step 2:

Social prescribing works better when we all work together. Connect with local arts in health practitioners to widen your creative freelancers’ network. You might be able to work with new practitioners who can offer arts in health activities on behalf of your organisation. Utilise free tools like London Arts and Health's Partner Up website to find practitioners to collaborate with, you could also work with local freelance experts to engage in funding bids.

Step 3:

Contact your local community GP or PCN and request to find out who the link worker might be. London Plus offers good resources and ideas for making this contact. Make them aware of the kinds groups and classes you offer, and how they might be relevant to someone looking to engage and be referred to arts and cultural organisations for health in your local area. Did you know? Arts and cultural practitioners also make great link workers. Find out more about link worker training and accreditation from the National Association of Link Workers.

Illustration of art teacher with child

This is not the case and more referrals are on the increase.

Be proactive, get out and about, and take time to build relationships with local arts and cultural organisations, arts and health freelancers and local community health organisations. Most referrals tend to come via GPs. But in our grant holders’ experience, relying on this route has meant some schemes struggled to find enough patients.

Ageing Better projects, which offer services to prevent loneliness for the over 50s, now aim for a mix of referral partners to ensure a constant flow of people. Working with partners that include adult health and social care, other local voluntary and community sector (VCS) organisations, and encouraging referrals from friends/family, including self-referrals has been more successful in identifying isolated and lonely clients than working with GPs and pharmacists alone.

You can expand your network by talking to a range of local organisations and residents. This could be through attending events run by local VCS support organisations or joining targeted networks run by larger charities such as Age UK or Mind. You can market your services directly to patients by advertising in local newsletters and newspapers, running open days, and organising taster sessions of activities at local community events.

Our podcast interviewing Veronica from Arts 4 Dementia explores referrals and how you might approach this.

Illustration of man playing guitar

Listen

To the podcasts

Watch

The animation

Further resources about social prescribing

There is an overwhelming amount of information about social prescribing, and it is hard to know where to start.

The best place to go for up to date information is theNational Academy for Social Prescribing, which is an organisation collectively pooling information and action about social prescribing across the UK. There are other resources that will also provide relevant information depending on what you are looking for.

NHS England Personalised Care, including links and information about social prescribing.

Kings Fund social prescribing explainer.

Social Prescribing Network, including conference information.

University of Westminster, making sense of social prescribing.

Culture Health and Wellbeing Alliance, information about social prescribing.

Greater London Authority, Healthy London Partnership, information about social prescribing.

A GLA-commissioned portal delivered by Simply Connect called Social Prescribing London is now online. Aimed primarily at the VCSE sector, this portal is also useful for link workers and commissioners in London.

Body Part Mapping
Body Part Mapping © www.tamalpa-uk.org

Case Studies

Portugal Prints is an artist community run by Mind in Brent, Wandsworth and Westminster with over 40 years of experience in helping people living with complex mental health needs through the therapeutic use of art.

Portugal Prints currently supports a diverse community of 35 artists from a range of interests, ages and backgrounds, most of whom rely on personal budgets to attend. By working closely with Community Mental Health Teams within the NHS, the organisation supports out of clinical settings and engages their artists in regular workshops that take the whole person into account.

The organisation receives the majority of its funding from personal care budgets and artists can be referred by their GP, psychiatrist or other mental health or social care professionals.

Artwork created by Portugal Prints’ artist

Artwork created by Portugal Prints’ artist
Artwork created by Portugal Prints’ artists.© Portugal Prints.

Performing Medicine is an initiative from Clod Ensemble, who have been delivering creative training programmes for NHS healthcare professionals and medical students for over 15 years using techniques found within the arts.

Performing Medicine works with 20 artistic professionals who collaborate with medical professionals to work on creative strategies for communication, wellbeing and self-care. This has led to the development of a methodological framework called the ‘Circle of Care’ which was developed with Guys and St Thomas' Trust and articulates how a multi-directional flow of care can build more effective caregiving. Their new training programme is focussed on social prescribing within Southwark & Merton and includes approaches to social srescribing in London for GPs, Link Workers and in particular lone arts and health practitioners. The training includes practical information about evaluation, referrals and articulating your social prescribing offer, ensuring that everyone involved in delivering the social prescribing process can feel prepared to engage with the whole approach.

Group of people

The image displays participants taking part in ‘Ageing well’ by Performing Medicine, at Dulwich Picture House.
Photo credit: Performing Medicine.

 

St. Margaret's House based in East London is an excellent example of a bigger organisation housing smaller, specific projects for community groups and looking to collaborate together to approach the delivery of social prescribing.

The building has been at the heart of the community for many years and has a range of artistic tenants who serve a variety of communities across East London. Stuart Cox, Arts and Wellbeing Director, says ‘building a relationship with our Tower Hamlets link worker is key for getting referrals. The collective nature of St. Margaret’s has meant strong partnerships and the ability to work together. For example, a group of us worked together to apply for funding from the Thriving Communities fund’. St. Margaret’s House has a wide range of workshops and companies, meaning that anyone referred can be directed to a suitable activity that’s most relevant to their social prescribing needs.

Bric a Brac Theatre performance at St. Margaret’s House.
The image displays participants taking part in a Bric a Brac Theatre performance at St. Margaret’s House.
Image credit St. Margaret’s House.

ENO Breathe is an online programme developed in partnership with Imperial College Healthcare NHS Trust that has been specifically developed for people recovering from COVID-19, who are still suffering from breathlessness and its associated anxiety.

Bringing together medical and musical expertise, the programme focuses on breathing retraining through singing; however, no experience or interest in singing is required to take part in ENO Breathe. The programme works in partnership with specialist long COVID-19 clinics across London and England. Patients can be referred to ENO Breathe by their GP, link worker or other healthcare professionals after being medically assessed by a specialist long COVID-19 clinic.

The programme has specific medical criteria for referrals in order to ensure safety. Participants engage in a free, six-week programme, working with an ENO vocal specialist. The workshops provide activities designed to support with breathing control and wellbeing, providing tools for the self-management of breath and anxiety. Digital resources support the online sessions (delivered in person on Zoom), by providing videos and downloadable playlists designed to reinforce the in-person learning. Once the programme has finished participants also have the chance to continue with fortnightly drop-in sessions online, keeping them connected in their recovery.

Photo Credit: Karla Gowlett

The Arts and Culture: Social Prescribing Myth Buster was created by London Arts in Health, and was  commissioned by the Mayor of London and his Culture and Creative Industries Unit.

The guide has been researched and written by Anna Woolf and London Arts and Health, with special thanks to Director Jenni Regan and Communications lead Neil Parker. Further thanks go to the wider GLA Culture and Health teams, in particular Jacqueline Rose, Clare Lovett and Mike Clewley for all their help and support.

London Arts and Health would also like to recognise and give thanks to all the key stakeholders who contributed to the research, development and feedback on this guide; including London Arts and Health members, podcast interviewees, members from St. Margaret’s House, and primary care staff who consulted on the material.

The Arts and Culture: Social Prescribing Myth Buster was designed by Keith Hagan.
The website design is by Louise at Scallywag Design.

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