3Improving health and wellbeing
95.Health was a dominant theme in the evidence that we received to our inquiry, with many organisations contacting us with us examples of the benefits to mental and physical health as a result of participation in cultural and sporting activities. We explored the extent to which cultural and sporting organisations are having a beneficial impact on physical and psychological wellbeing, and whether these interventions could help the UK tackle the demographic health challenges it is currently facing.
96.In the time that we have been undertaking our inquiry, Health Secretary Rt Hon Matt Hancock MP has described the arts as essential to health and wellbeing.195 This builds on the impetus within the cultural sector in recent years to quantify the impact of the arts on health,196 notably through the Cultural Value project197 and work of the All-Party Parliamentary Group on Arts, Health and Wellbeing.198 This work was highlighted by several submissions, indicating its potential to inform future policy. The All-Party Group found that the positive impact of the arts on health is strongest in tackling psychosis in young adults, postnatal depression, recovery from neurological damage and falls prevention in older people.199 In their evidence to our inquiry, cultural organisations described the positive impact they are having across the whole health spectrum, from prevention to supporting people recovering from ill health to helping people living with long term conditions.200
97.Wight Harmony201 is a male barbershop choir on the Isle of Wight. One participant commented: “I have found that my recovery from bowel cancer has been enhanced by my association with barbershop singing. My relationship with fellow singers is in no small way responsible for my recovery. It is quite diverse from any hobby or pastime that I have been involved in the past, but having said that, it’s one of the best moves that I have made in my life. Learning to enunciate and sing correctly has been a source of great inspiration and education for me.”
98.Sports and Civil Society Minister Mims Davies MP told us that the DCMS will “advocate for the role of arts and culture” in meeting the aims of the NHS.202 Over the last three years, Arts Council England has invested more than £23 million in organisations working towards health and wellbeing outcomes.203 Analysis of data on arts participation rates in England estimates that the total annual NHS cost savings due to reductions in GP visits is £168.8 million.204 Susannah Hall, Head of Arts at Great Ormond Street Hospital for Children, told us that while arts in hospitals are “funded in all sorts of ways”205 her team is funded through the hospital’s charity rather than directly from the NHS.
99.Dance to Health206 is a nationwide community dance programme for older people that combines evidence-based physiotherapy with the creativity, expression and energy of dance. The programme is running in six areas of England and seeking to reduce falls amongst older people. Dance to Health has been oversubscribed and has been found to reduce GP visits by 50%. Run by arts charity Aesop the programme offers an effective, financially sustainable model which could grow to benefit many older people across the UK at the same time as reducing NHS spending.
100.In our inquiry we found that the link between arts and health has the richest evidence base. Dr Daisy Fancourt from University College London told us:
We have fantastic case studies, [of the positive impact on arts on health] but we also have incredibly rigorous research that shows the benefits of this. This is not something that is just based on anecdote anymore. We are seeing huge buy-in from multiple different sectors. Personally, I have worked with over 100 NHS trusts in the last few years, had thousands of patients involved in studies, and got hundreds of major national arts and cultural organisations involved in this. We are also seeing big interest outside the UK.207
101.However, Dr Fancourt noted that the evidence base has developed largely at a grassroots level. Many organisations that submitted evidence to our inquiry used self-reported wellbeing, captured as part of specific programme evaluations, to demonstrate the value of cultural participation.208 There have also been attempts to create a common methodology to quantify health impact for the whole cultural sector209 and to ensure that data on the value of arts is presented in a way that makes the case to health commissioners.210 This gap between grassroots evidence and health commissioning is an obvious area where the Government could provide greater support.
Social prescribing
102.Social prescribing is a scheme that enables GPs and other frontline healthcare professionals to refer people to activities in their community instead of only offering medication.211 It is currently used by around 60% of local health commissioners.212 Our evidence suggests that social prescribing is playing an increasingly important role in connecting health and the arts but that the potential of the scheme is yet to be realised.213 Arts on Prescription courses in Cambridgeshire and Peterborough led to a 73% decrease in reported depression,214 the Artlift scheme in Gloucestershire delivered a cost saving of £471 per patient,215 and 68% of participants in the Reading Well Books on Prescription scheme said their symptoms improved as a result.216 Alastair Campbell, mental health campaigner, said:
I do not think we are even at the beginning of discovering the opportunities in peer-to-peer groups, social prescribing and that kind of thing, which can help deliver better services for people who need them.217
103.Susannah Hall suggested that social prescribing could be a mechanism to move funding for arts health interventions out of discretionary or charitable funding into core health service budgets.218 Our inquiry heard that one model of social prescribing uses link workers219 who are abreast of what is available in their area, and who support GPs to make referrals,220 and that there are intermediaries who can specifically match arts organisations to health commissioners.221 Mr Campbell told us that social prescribing could be particularly beneficial to people living with mental illness, and that this would be more cost effective than medication.222 The Department of Health told us that more evidence is needed on cost effectiveness, and so NHS England will be publishing a standardised model and outcomes framework for social prescribing, allowing more data to be collected.223 In the summer of 2018, while we were undertaking our inquiry, the Department of Health and Social Care announced additional investment in 23 social prescribing schemes.224
104.Several organisations described the power of the arts to both help delay the onset of dementia and improve quality of life for people living with dementia.225 For example, charity Rhythmix and Bournemouth Symphony Orchestra deliver live music sessions in dementia wards and units.226 Historic Royal Palaces have developed the Sensory Palaces programme, delivering dedicated sessions at their sites for people living with dementia and their carers. One participant commented, “there were a lot of things that I knew, there were things that I didn’t know and there were things I’d forgotten! So, all in all, it gave me an enthusiasm’”.227
105.National Museums Liverpool’s House of Memories training programme has reached 12,000 dementia carers and delivered over £12 million of social value.228 Sefton Library Service record the life stories of people with the beginning of memory loss, providing a reminiscence tool for the patient and supporting the local history archive.229 Participatory arts charity Spare Tyre230 has worked with more than 4,000 people with dementia nationally in care homes, day centres, community centres and cultural venues. A manager in one of the care homes involved said “this work has the ability to change the culture of how we work with older people with dementia […] a really amazing level of interaction was achieved.” The Department of Health and Social Care told us that arts interventions “do not slow down the progression of dementia, but they are playing an increasing role in helping people to cope with the emotional and cognitive effects’”.231
106.The full health impacts of cultural programmes are far from being reached. The DCMS should take the opportunity of the expansion of social prescribing to work with the Department of Health and Social Care to test how far prescription of arts and sports interventions can be mainstreamed in the 23 areas; to develop closer links between commissioning decisions and arts and sports programmes and organisations; and to assess how self-reported wellbeing can be better integrated into health commissioning processes. At present, there appears to be little collection of evidence by Government of the cumulative benefit of cultural programmes, despite the enthusiasm of the organisations who have seen huge benefits.
107.The DCMS and DHSC should ensure that NHS England’s forthcoming outcomes framework and guidance on social prescribing includes information about the power of arts and sporting interventions to improve both physical and mental health, and work to extend the availability of cultural benefits to more people affected by such conditions. The DCMS should track the evidence base on cost effectiveness that develops as a result of the use of this guidance.
Sport and health
108.There is a well-established link between physical activity and health, in terms of physical fitness, and consequent reduction in risk factors for many long-term diseases.232 Physical inactivity is estimated to cost the NHS £1 billion a year, with wider social costs totalling £7.4 billion a year.233 There is also a link between physical activity and wellbeing. Alastair Campbell described the mental health benefits of participation in straightforward terms:
One of the worst things about depression is the feeling that you do not want to go and do anything. You do not have the energy or the desire to go and take exercise, but you might if it was in your diary every Tuesday and every Friday: this is what you are going to do and these are the people you are going to go with, and you know you can talk to them and so forth.234
109.Much of the evidence that we received was from sports clubs working in their communities to increase participation and deliver consequent health benefits. While there is no standard method for evaluation,235 sporting organisations measured their impact on both physical health and mental wellbeing. Many organisations placed at least as much of a premium on mental wellbeing as on physical health. For example, walking charity Living Streets reported that 80% of participants on their programme for older people felt less stressed or anxious and 76% felt fitter or healthier as a result236, while parkrun told us 95% of people doing free timed runs in their local park said that they felt both healthier and happier and 97% said they felt more positive as a result.237 Crawley Town Community Foundation used football coaching and other activities to support people experiencing or at risk of experiencing mental health problems, with 78% of participants strongly agreeing that the project had given them a positive activity to focus on.238
110.Dementia was a particular mental health focus for some of the sporting organisations that submitted evidence to our inquiry. Swim England ran a three-year project with 48 leisure centres which has led to over 1,250 people with dementia having improved mood, higher cognitive and physical ability, and reduced anxiety as a result of taking part.239 Many county cricket grounds are running designated ‘dementia days’ to give people with dementia an opportunity to reconnect with cricket.240
111.One participant in Let’s Get Moving, a 12-week structured physical activity programme commented “When I started Let’s Get Moving, I suffered with depression—to a point where I would find it a struggle to get off the sofa to do everyday things. Being more active has really helped with that—I feel so much more motivated to do more and get on with everything. Each day I feel more and more motivated to do things—even things that I’d never normally do, such as walking for that bit longer or actively taking the kids outside to just do something. I’ve been feeling so much better in myself that I’ve started to cut down on my antidepressants! The extra bits of activity that I’ve been doing has also meant that I’m losing weight, which is really good”.241
112.It’s clear that sporting organisations are also working to ensure that all groups can benefit from sporting participation. Charlton Athletic run a football skills programme for children and adults with Down’s Syndrome,242 DanceSyndrome runs community dance workshops and dance leadership training for people with learning disabilities,243 the England and Wales Cricket Board estimate that in the last three years over twenty two thousand people have taken part in community or club disability cricket,244 and 41 percent of participants in the Premier League Kicks programme were young people from a minority ethnic background.245
113.Walking football is aimed at people over 50 who cannot play traditional football for mobility or other reasons. Many of the football organisations who submitted evidence to our inquiry run such initiatives, reporting benefits including weight loss, improved fitness and improved mental health for participants.246 During our visit to Manchester City Football Club, we saw first-hand how walking football had provided a route back to sporting participation for older men who had previously enjoyed playing regular football, with participants telling us about how the sessions have helped to reduce social isolation. This was also reflected in the written evidence that we received. Derek, who plays walking football at Fleetwood Town Football Club commented, “I must state that on its own walking football is not a cure for my problems but it’s a big help. I still have to take what I call dizzy pills and loopy pills, making fun about anything and everything is now priority because that’s what walking football is all about.”247
Social prescribing
114.Similarly to the evidence that we heard about the impact of social prescribing on linking arts to health, we found that the scheme can deliver benefits through sport and physical activity. More than four out five people referred to East Riding of Yorkshire Council’s exercise on prescription scheme completed the programme, with 88 percent saying they felt healthier and 62 per cent saying they “felt better about themselves” as a result. Fusion Lifestyle reported savings to the public purse of £1.1 million from the exercise on referral schemes that they ran in 2014,248 and a physical activity referral scheme in Sheffield reported £3.42 worth of benefits generated for every £1 invested.249
115.Youth charity StreetGames run a range of programmes to take sport ‘to the doorstep’ of disadvantaged communities, including areas with high levels of inactivity. Their programmes include using sport to improve mental health, and working in schools to target inactive children. StreetGames have found that their sporting programmes have delivered a tangible impact on physical activity rates, subjective wellbeing and self-esteem of the disadvantaged young people who have taken part.250 The charity is playing a lead role in gathering best practice evidence of the impact that youth organisations can have on improving the health of young people, with a view to developing new guidelines for social prescribing link workers.251
116.We also came across examples of prescribing being used to deliver social as well as physical health benefits. The Tennis Foundation takes referrals from GPs to not only help people be more physically active but also to increase their social interaction and social network.252 This echoes recent recognition from the Government of the role that social prescribing that play in reducing loneliness.253
117.We reiterate our earlier recommendation about the importance of Government support for social prescribing. We also recommend that DCMS approach sporting organisations to encourage their participation in social prescribing schemes, which can go beyond physical health benefits to include social impacts such as tackling loneliness.
195 Matt Hancock, The power of the arts and social activities to improve the nation’s health 6 November 2018
196 For example, Professor Helen Chatterjee [SCS0201], BOP consulting [SCS0193], HC Deb, 11 October 2017 col143WH
197 Geoffrey Crossick and Patrycja Kaszynska Understanding the value of arts and culture: the AHRC cultural value project March 2016
198 During 2015–17 the All Party Parliamentary Group on Arts, Health and Wellbeing conducted an inquiry into the benefits that the arts can bring to health and wellbeing.
200 For example, LIME Music for Health [SCS0042], Great Ormond Street Hospital for Children NHS Trust [SCS0010], Age UK [SCS0045] , Nottingham Contemporary [SCS0048]
205 Q192
206 Case study supplied by All-Party Parliamentary Group on Arts, Health and Wellbeing [SCS0078] para 12 and Nesta [SCS0110] para 1.7 and 1.8, further information taken from www.dancetohealth.org
207 Q181
208 For example, National Youth Theatre of Great Britain [SCS0114], Bristol Culture [SCS0069] para 3, and Streetwise Opera [SCS100] para 14–15
210 Q55 [Darren Henley]
211 Kings Fund What is social prescribing? February 2017
217 Q179
218 Q195
219 NHS England describes the role of link workers as offering ‘people time, focusing on ‘what matters to me’ and taking a holistic approach to people’s health and wellbeing. They connect people to community groups and statutory services for practical and emotional support. Link workers also support existing community groups to be accessible and sustainable, and help people to start new groups, working collaboratively with all local partners.’
221 Q206
222 Q199
224 Department of Health and Social Care Social prescribing schemes across England to receive £4.5 million 23 July 2018 [accessed on 15 January 2019]
225 Q222–225, Dr Daisy Fancourt [SCS0248], further case studies were also provided by the Baring Foundation [SCS0023]
226 Rhythmix (wishing well) [SCS0060] para 15–22, Arts and Health South West [SCS0174] para 5, Association of British Orchestras [SCS0112] para 5.6
228 National Museums Liverpool [SCS0073] para 4.1.1–4.1.8, National Museum Directors Council and the Museums Association [SCS0131] para 8
233 NICE guideline Physical activity and the environment March 2018
234 Q199
235 Q24
253 HM Government A connected society A strategy for tackling loneliness – laying the foundations for change October 2018
Published: 14 May 2019