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The impact and future of social prescribing: Wellbeing, evidence, partnership and approach

Social prescribing involves helping patients to improve their health, wellbeing and social welfare by connecting them to community services which might be run by the council or a local charity.

What are the opportunities for personalised care to connect people to music and the arts including through social prescribing and the role of link workers?

In his blog, published on Music for Dementia’s website, James Sanderson, Director of Personalised Care for NHS England, makes an important argument for the role of participatory arts – and music in particular – in helping people take a proactive role in their health journey.

Spirit of 2012 currently funds a number of projects that work within local health and social care infrastructures to enable people to become active – physically or creatively – to support and to strengthen their mental and physical health. The Music Challenge Fund is our most recent example of this, including projects such as Our Day Out, delivered by Creative Arts East in Norfolk. These projects recognise the complexity of a participant’s health journey, and that the health of a whole person can ultimately be supported by a number of key factors. As James writes:

In modern medicine, for example, many of the challenges people face cannot always be solved by an appointment, medication or an operation. What keeps us well or helps make us well is so much more complex than this.

James Sanderson, Director of Personalised Care for NHS England

What have we learned at Spirit of 2012 about the connection between health & wellbeing and participation in creative activities?

  1. Connection is fundamental to a complementary healthcare approach.
    At Spirit of 2012, we believe that it’s the approach, not the activity, that improves wellbeing. This is not to say that we disregard the emerging evidence that links specific interventions to personal health and wellbeing outcomes. However what we do know is that the cup of tea, the welcome, and the opportunity to have a chat sets a strong foundation for a successful session, regardless of the activity. These moments of personal connection within a group  - small or large – who have gathered for a shared purpose are what make participatory activities different from a one-to-one visit to the doctor’s, and can create a complementary, well-rounded care framework.
     
  2. Independence and confidence to seek support grows from connection.
    We have evidence that patients with chronic mental and physical health conditions can become more proactive about seeking care as a result of participating regularly in creative activities. We hear from our grantees about participants who have progressed to taking more of a leading role in their treatment, having been initially referred to sessions reluctantly or with low levels of confidence. In one case, as lockdown took hold, a project member with a chronic mental health condition sought online music lessons with a project lead as she recognised its fundamental role in maintaining her wellbeing while in isolation.
     
  3. We are gathering evidence that music participation can help people regulate emotions, and maintain wellbeing in those with a degenerative cognitive illness.
    Early findings of research conducted by the International Centre for Community Music with 23 participants of the Seagull Café (a session run by More Music in Morecambe for people over 60) revealed that participants identify singing as giving them positive emotional benefits. In particular, participants strongly agreed with the phrases “[participation in singing] helps me to disengage from things that are bothering me”, and “[participation in singing] redirects my attention so I forget unwanted thoughts and feelings”.
     
    Additionally, Creative Arts East’s Our Day Out project found that: “even within a progressive disease, such as any type of dementia is, wellbeing can be enhanced after relatively short-term activities such as offered by Creative Arts East for the participants in this evaluation. Across 7 sessions, wellbeing increased at a statistically significant level (comparing pre and post scores) for each session." *
     
    These findings link closely to recently published research from the What Works Centre for Wellbeing, which found that intangible cultural assets (such as participatory arts and leisure activities) can impact wellbeing and loneliness by offering opportunities to connect with others, and a means to cope through sharing and self-expression. We are keeping a close eye on findings like this, and hope to form a greater understanding of this as more long-term data becomes available.
     
    *These findings were obtained from statistically significant evidence following Canterbury Wellbeing Scale measurements taken before and after 8 fortnightly sessions.
     
  4. A successful partnership between the arts and a health partner is not just a signed piece of paper.
    Projects that actively involve health and/ or social care workers in the sessions report a greater ability to further personalise a patient’s care, from both the arts and health partners’ perspectives. Sessions in which a social worker supported participants with a learning disability led to more appropriate, bespoke participation and evaluation approaches, improving the arts organisation’s toolkit to adapt and to be more inclusive. On the other side, sessions in which a GP is involved have led to referrals for treatment, as members felt safe in the creative environment to disclose health concerns. A Music Challenge Fund project member received treatment for a minor stroke after other participants encouraged him to speak about his symptoms with the health worker taking part in his session.
     
  5. A wider community approach, if possible, yields the greatest possibility of success
    Doncaster has a Health and Wellbeing Board made up of partners from the arts and health sectors in the city. Its logic model and action plan underpin a strong commitment to building capacity, increasing engagement and widening its research to support a partnership that is ready to respond to health challenges in the community. Creative Directions in the Community, funded by Spirit of 2012, emerged as a result of this cross-sectoral work, and since it began  has seen greater investment in similar projects in other parts of Doncaster.

How can funders support the advancement of social prescribing programmes?

  1. Remember that numbers do not tell the whole story
    At Spirit, a major facet of how we support grantees is in understanding the impact of sustained participation in an activity, or set of activities, for individuals and their communities. With this comes a keen awareness that the success of a funded project cannot be measured by participant numbers alone. Arguably, placing too much emphasis on numbers can do more harm than good. Focusing on the head count can encourage organisations to focus on those who are easiest to get through the door, rather than reaching those who might stand to benefit the most.
     
  2. To truly understand the impact of a project, funders must fund and closely support evaluation
    Funders should support projects to develop their evaluation frameworks at the bid stage, to ensure a spirit of curiosity and learning is baked into the project’s foundations. During delivery, support and funding for measuring impact in a dynamic, responsive and proportionate way is key. Funders should allow, and expect, projects to take the space to pause and adjust their processes according to what the data reveals . A buy-in to an evaluation approach should also be agreed with health partners. The future of projects such as those identified above will rely on their ability to confidently communicate their impact to the health sector, the arts sector and to local and national government. By funding evaluation, you are investing in the future of social prescribing programmes!

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