National Partnership for Culture: independent report

3. Health and Wellbeing

3.1 The Scottish Government should be charged with ensuring that culture is employed as a key part of delivering Health and Social Care priorities and contributing to an overall wellbeing economy.

The Culture Strategy recognises the impact that culture can make on tackling health inequalities, preventing mental and physical illness and promoting recovery and general wellbeing. The connections culture has with health and well-being are increasingly recognised in research, as well as in clinical and policy settings. Culture can play an important part in assisting the delivery of the PfG's health commitments, including the delivery of a mental health and wellbeing service by 2026.

However, for this to be successful, it is imperative that the underpinning principle outlined in the introduction to this report is accepted. That is to say, the mainstreaming and mass participation of culture will be essential if the potential of culture as a driver of Scotland's progression to a Wellbeing Economy is to be realised. Without this, there is a risk that deploying culture to improve wellbeing could actually increase health inequalities. This is a strong illustration of the interconnected nature of the recommendations presented in this paper. The ambitions articulated in this section cannot, for example, be achieved without the related enablers of equitable provision of cultural education for young people (1.1) and the national prioritisation of equity of access to culture through supporting local, grassroots delivery (2.2).

Synergies, ideas, and good practice spanning culture and health policy areas are shared across existing national and local networks, but the approach is often not strategic, and successes can be undermined by the prevalence of short-term project funding. Low awareness of the evidence related to cultural interventions on health outcomes, combined with preconceptions about its quality and relevance are also barriers to the scaling-up of projects and initiatives in this space, even where these projects have been shown to be successful.

The Scottish Government should commit to joint programming at Ministerial level to develop approaches to health and wellbeing which include culture as a means to support delivery of health outcomes. In particular, this should involve cross working between culture and proactive and preventative care, population health and wellbeing, and health workforce wellbeing. This aligns with the Christie Commission recommendation to take a preventative approach to healthcare services.

Ongoing projects which demonstrate existing cross working include: the Art for Baby project at GoMA; Grampian Hospitals Art Trust – supporting NHS staff; Art in Action (ArtLink's work with Health and Social Care Partnerships to support people with profound disability); and Time to Dance by Scottish Ballet. However, it can be challenging to embed an understanding of the impact of this work within professional healthcare settings. To realise the value of culture in supporting health and social care priorities, the Scottish Government could resource and reinstate Creative Community Link Workers in local authorities to embed cultural approaches locally, as well as build stronger links with COSLA around culture and health. There is likely to be a role for Public Health Scotland in this work.

Scottish Government should commit to embedding culture in NHS training programmes, in particular Leading for the Future^[12] and Project Lift^[13] (or their successor programmes), to ensure health workers understand the evidence and how to maximise existing resource. Working with NHS Education for Scotland (NES) would be key in supporting the delivery of this recommendation. Support in Mind would also be well placed to support in the delivery of this recommendation.

3.2 Scottish Government should make connections at Ministerial and policy level to highlight the impact that social prescribing can play and identify the role of culture in nurturing and scaling work in this area.

Social prescribing is a model that can achieve significant health benefits, sometimes where other support and intervention has not been able to achieve success.^[14] There is clear evidence that social prescribing is an area which can help relieve increasing health and social care pressures. In the UK, up to one fifth of patients see a GP for a problem that requires social prescribing.^[15]

To make connections to ensure that culture is included and recognised as valuable in social prescribing, Scottish Government should encourage and develop awareness and training for those in clinical and community settings on the efficacy and appropriateness of cultural approaches to support preventative care, which can be used by care givers as an option to individuals developing their own care plans. The Scottish Government should also develop programmes to support artists and creative practitioners who want to work in health and wellbeing and enable them to develop creative interventions that have positive impacts in these areas. There is a spectrum of work in place in this area, from clinical/therapeutic practice to working with specific groups of health vulnerable people, to more general wellbeing work. Engaging with Higher Education Institutions is key, ensuring that degrees prepare relevant students with the necessary skills to work professionally, ethically, and to a high-quality standard in this area.

3.3 A dedicated funding stream for culture initiatives should be developed within the health portfolio.

Cultural activities can play an important role in a preventative spend agenda, and there is evidence suggesting that in many care contexts they can be cheaper, more accessible, and less risky than some clinical interventions.^[16] The cycle of short-term projects with time limited funding is a broad and significant problem across the culture sector: it takes time to raise awareness of social prescribing initiatives, and this often occurs as short-term projects are coming to an end, limiting their potential impact, and in some cases risking having a detrimental impact on those who had been involved by removing access to something they had come to value and rely on. The short-term nature of projects makes referral difficult for health professionals.

The Scottish Government should commit to a dedicated funding stream for culture initiatives within the health portfolio and developing a referral infrastructure. That is not to say a redirection of funds from health priorities, but to build on and formalise the savings that culture provides to the health portfolio due to its positive influence on preventative spend. This should be designed in a way that empowers artists and creative practitioners to develop and deliver cultural programmes, which should be evaluated in a way that supports cross sector learning and the sharing of best practice. This funding and the related referral infrastructure should also be simple and accessible to artists and organisations who are charged with delivering this, but do not necessarily understand how to navigate complex NHS processes.