The NCCH aims to advance good practice and research, inform policy, and promote collaboration, to create the right conditions for creative health to be integral to health and social care.
Creative health is defined as ‘Creative approaches and activities which have benefits for our health and wellbeing’. Activities can include visual and performing arts, crafts, film, literature, cooking, and creative activities in nature, such as gardening. Approaches may involve creative and innovative ways to approach health and care services, co-production, education, and workforce development.
A creative health strategy
In 2022, NCCH and the All-Party Parliamentary Group on Arts, Health, and Wellbeing launched a Creative Health Review, with the aim of making recommendations to the Government and Metro Mayors for a cross-departmental strategy on creative health that will support the practice to flourish. As part of the process, we held a series of themed roundtables and gathered evidence and examples of the benefits of creative health, in relation to key policy areas.
Recognising the pressing challenges currently faced by the social care sector, including increasing demand, underfunding, and workforce capacity, we identified social care as a key theme and one where we think creative health can make a real difference. Here we outline the impact creative health can have on social care settings, particularly care homes, and how by further embedding creative health into health and social care systems its benefits could be felt more widely, improving conditions for individuals, carers, the workforce, and, ultimately, systems themselves.
A wealth of benefits
Creative health can benefit people of all ages, but creativity can be particularly impactful as we age and provide a source of meaningful engagement and social connection. NICE guidelines recommend that group singing, arts, crafts, and other creative activities are provided for older adults at risk of decline in independence and mental wellbeing.
Creative health can also have physical health benefits. We know that dance and movement can provide an enjoyable and accessible way to increase physical activity, improve balance and reduce frailty, leading to a decrease in the risk of falls. Singing can be used effectively to ease symptoms of respiratory conditions such as COPD, whilst music and movement can support people in their recovery from a brain injury or stroke. Singing for Lung Health interventions, consisting of a 12-week singing programme for people with COPD has been shown to reduce healthcare utilisation, including GP visits and hospitalisation and improve respiratory-related quality of life.
There is strong evidence for the use of creative health approaches in relation to dementia. Research tells us that a range of creative activities, including dance, music, art, and storytelling, as well as cultural engagement can help to prevent cognitive decline in older adults. For people living with dementia, creative activities such as music-making, singing, dance, and visual arts can have benefits for speech, cognition, and memory. Creative health can reduce anxiety, depression, stress, and aggressive behaviours, and can provide social opportunities. When creative activities are delivered with family members or carers, both parties can benefit from the wellbeing impact.
In the current context, meeting even basic needs in social care can be a challenge for providers. As a recent House of Lords report by the Select Committee on Adult Social Care, A Gloriously Ordinary Life, finds:
‘Services are effectively considered sufficient if they meet individuals’ basic needs. There is little thought given to exploring, acknowledging, or meeting a person’s ambitions and desires, let alone to helping them find the means to accomplish their goals’.
As a holistic and person-centred approach, creative health moves beyond basic needs, and supports people to engage in creative activity that is meaningful to them, thereby improving health and wellbeing.
Creative health in care homes
Just as in the community, creative engagement in care homes is beneficial for health and wellbeing. There are fantastic examples of diverse forms of creative activity taking place in care homes including filmmaking, opera, dance and movement, poetry, exploring museum collections, and circus skills. These activities bring joy to residents and staff alike and have been shown to improve health and wellbeing outcomes. For example, participatory arts and crafts can build social relationships and reduce loneliness. Live music performances provide a sense of achievement and empowerment. Care home managers report positive changes in residents, including those with dementia, improvement in interactions with staff, and even a reduced need for medication. Furthermore, these activities have been shown to provide a good social return on investment.
Evaluations of creative initiatives have also shown positive impacts on staff wellbeing in job satisfaction and retention. In our Creative Health Review roundtable on social care, we heard from Live Music Now about how its Live Music In Care residency programme works to improve wellbeing across the whole care home, with benefits to residents, carers and managers.
The programme works with care homes over several months to embed musical activity, building confidence and skills in staff to be able to lead music activities and to use music in their day-to-day care tool kit. In this way, the programme has long-term sustainable benefits for the whole care home. Care home staff have also reported that the activities can change the environment within the care home, and have observed positive changes in behaviours, reductions in levels of anxiety and distress and improved confidence, even leading to a reduction in the use of medication. One care home reported a 50% decrease in the use of sedatives and a 100% decrease in PNR medicine administered on demand. Staff working in care homes can use music to support residents who are feeling anxious or worried.
‘In the evening, they get very agitated and worried. In their reality, many feel they should be going home, making partners’ meals, looking after their houses and families. They think they are being held against their will preventing them from doing this… I can bring the music back into the conversation and it brings back the feeling of peace, calm and joy and gives something in my tool bag and breaks that cycle (perhaps stopping me being hit)’ – Activities Co-ordinator in a care home.
Developing the health and care workforce is integral to the Live Music in Care model. Training, co-planning and reflection time are built into the model of delivery led by the musicians and standalone training opportunities are also available for professional development.
Maximising the potential
The extent of provision is often dependent on the enthusiasm of the care home manager, and while extremely good examples of best practice exist, a system-wide approach including both the arts and social care sectors, with leadership from the Government is required, to ensure all care home residents can access the benefits.
The National Activity Providers Association (NAPA), which runs the Arts in Care Homes Programme, suggests that a cultural shift in the understanding of the benefits of creativity in care homes along with specialist training and more widespread partnerships between care homes and community organisations and arts providers could support more widespread availability. A key element of the NAPA Arts in Care Homes programme is the National Day of Arts in Care Homes, an annual event that takes place on 24th September each year. Running throughout the pandemic, the National Day has sparked a change in attitudes towards creativity in care settings.
Preparing for regulation
A recognition of the value of creative health approaches in CQC regulatory assessment frameworks could act as a strategic driver for healthcare systems, local authorities and private care providers to prioritise provision within care settings. It will also help to create a sustainable and scalable infrastructure to support creative health practitioners working in this area.
During the social care roundtable, Karen Culshaw noted that CQC would welcome any good examples of creative health in social care settings when providers have contact with CQC. In response, people asked how to showcase such examples. Karen suggests, ‘CQC encourages care providers to be open, honest and proud with inspectors during any inspection or requests for information in regard to things which are making a difference to people’s quality of life, including creative activities. Under the new assessment framework, there will be places where this type of evidence could be used. For example, under the new ‘caring’ question there is a lot of focus on people’s emotional wellbeing, connecting with the community and activities that matter to them, reflecting people’s cultural, social, and personal needs and preferences in how care is delivered, etc.
Also, there are other areas where creative activities could be used as positive evidence such as workforce wellbeing and enablement to provide personalised care, and a considered person-centred approach to how to meet people’s holistic needs. We are already interested in how providers are delivering person-centred care to people, including the use of creative approaches, but this will be strengthened further in the new way we work.’
A personalised approach
In the face of huge challenges, we need to rethink the way we approach social care. Recent policy documents and reports from organisations working in the sector have pointed to a shift towards integrated and personalised approaches. However, in practice, social care services are struggling to meet basic needs. We must address the needs of the whole person in the context of the lives they wish to lead.