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The testimony of patients themselves is eloquent. Listeners to “Music Matters” on Radio 3 last Saturday heard a person with bipolar affective disorder speaking

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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,

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

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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 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.

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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:


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.

5.11 pm

Baroness Sharp of Guildford: 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

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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

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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.

My final quote is from a lady who says:

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.

5.20 pm

Lord Mawson: 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

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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

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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

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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.

5.30 pm

Baroness Neuberger: 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.

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