NCCH Responds to the Government’s Call for Evidence on a Major Conditions Strategy

Creative Health has many benefits for people living with common illnesses, such as cancer, cardiovascular disease and dementia. We highlighted these benefits to the Government in a recent call for evidence.

The Government has announced its plans for a Major Conditions Strategy, which will set out how to tackle the conditions which contribute to the biggest burden of disease in England. The strategy will build on the NHS long-term plan, with a shift towards integrated, whole-person care. It is intended to relieve pressure on the health system, as well as improve healthy life expectancy, in line with government targets. The call for evidence asks for suggestions for how to improve health outcomes for people with cancers, cardiovascular disease (including stroke and diabetes), chronic respiratory diseases, dementia, mental ill-health and musculoskeletal disorders. It also seeks information on impactful interventions that can be adopted and scaled quickly, and how inequalities in outcomes and experiences can be reduced.

In our response, submitted jointly with the Culture, Health and Wellbeing Alliance and Lived Experience Network, we highlighted evidence demonstrating how creative health can help prevent the onset of disease and treat and support people living with these conditions. We provided examples of where this has already been put into practice in healthcare settings, and emphasised the importance of joined-up approaches and sustainable partnerships between creative, cultural and community assets, which not only support people to manage their conditions, but can prevent the onset of disease, and create the conditions for people to live healthier, longer lives.

Creative health and major conditions

There is a strong and rapidly growing evidence base supporting the use of creative approaches in the prevention, management and treatment of the conditions included in the strategy. For example, singing has been found to be beneficial for people with chronic respiratory diseases (including COPD and asthma). Singing exercises can help to regulate breathing patterns and improve lung function and capacity, reducing breathlessness. As well as improving quality of life and wellbeing for patients, singing for lung health programmes have been shown to reduce admissions to A&E and GP appointments, and offer value for money – read more about Mindsong’s Breathe in Sing Out programme here. These benefits have also been utilised for long-covid recovery, with ICSs such as East Suffolk and North East Essex working with local arts organisations to develop innovative creative programmes for long-covid patients.

Around 5.4 million people are living with cardiovascular diseases (CDV) in England. Creative health activities can help to prevent the onset of CVD by offering opportunities for gentle exercise or relaxation. Creative health also supports those with CVD, aiding recovery from heart attack or stroke. For example, music, movement and performing arts are used in the rehabilitation of people who have suffered a stroke, and have been shown to lead to improvements in physical capabilities such as walking and standing, cognitive benefits, and improvements in mental health and general wellbeing. A large-scale research study is currently underway investigating the implementation and scalability of Stroke Odysseys, a post-stroke performing arts intervention, which can be delivered in hospital and community settings.

Dance can improve strength, mobility and balance, which can prevent falls, especially in older adults, helping people to maintain good musculoskeletal health. Dance to Health was developed to address the large number of over-65s admitted to hospital due to falls, and has shown improvements in physical and mental health as well as a reduction in falls.

There is extensive evidence of the positive effects of creative health for people living with dementia. Creative and cultural engagement can reduce cognitive decline, and improve quality of life for people living with dementia. In our Creative Health Review roundtable on social care we heard more detail about the benefits of music and singing for people living with dementia, and how culturally appropriate multi-sensory performances can meet the needs of minoritised groups, which may be underserved by traditional services. You can hear more about these examples here.

We reiterated the many benefits of creative health for mental health and wellbeing, previously submitted in our response to the Government’s consultation on a Mental Health and Wellbeing Plan (now incorporated in the Major Conditions Strategy). With rising rates of mental ill-health a concern, particularly among children and young people, ensuring we maximise the potential of creative health is also a priority of the Creative Health Review. To find out more about this theme, you can watch our roundtable here.

Whilst there are specific benefits that creative activity can have for major conditions, creative health also offers a holistic and person-centred approach to health and wellbeing. Many people will live with two or more chronic conditions at one time. Multimorbidities have a significant impact on people’s quality of life. They can be complex to treat, and are costly for healthcare services. Creative activities can have positive physical health outcomes and improve mental health and wellbeing at the same time. When creative activities take place in groups or social settings, they can help to alleviate loneliness and isolation, which can be associated with chronic conditions. As part of personalised care, they can provide patients with choice over the treatment they wish to receive, and through supporting people to manage their own self-care, creative health can empower people to take control over other aspects of their lives, improving overall wellbeing and quality of life. This has benefits for individual patients and health and social care services.

Community gardening is a good example of a creative health activity with multiple benefits. Gardening can provide an enjoyable route into physical exercise, and has been shown to reduce stress and improve overall wellbeing. It can also lead to better knowledge of food and nutrition, leading to changes in diet, as well as increasing environmental awareness and connectedness with nature. In this example of a community allotment in Gateshead, GPs regularly refer patients and have seen improved outcomes in mental health, dementia and frailty.

Prevention and reducing health inequalities

Individual long-term conditions and multimorbidities are linked to health inequalities. They are common in people living in less affluent areas, and there are racial inequalities in both prevalence of the major conditions and in experiences of healthcare services.

It is therefore vital that reducing health inequalities is central to the major conditions strategy. Tackling the social determinants of health – non-medical factors such as income, housing and education, which account for a high percentage of health and wellbeing outcomes – will help to prevent the onset of disease and reduce the burden on the health service in the future. We know that engaging with creative, cultural and community assets is good for physical and mental health, and can be particularly impactful for people living in disadvantaged areas. Creative health can act across the social determinants of health to improve outcomes, and facilitates inclusion health, through the co-production of appropriate and accessible health services. Embedding creative health as part of an upstream, preventative approach to health will not only keep individuals healthier for longer, but can help to tackle health inequalities, and contribute to levelling up and increased productivity over the long-term.

The strategy should therefore reflect the importance of holistic and whole-system approaches to health, including the role of creativity and culture in improving the environments in which people live, and creating the conditions which enable people to live longer, healthier lives.

The links between creative health and health inequalities were the focus of one of our Creative Health Review roundtables. You can find more information here.

Implementing and embedding creative health to address major conditions

Creative health approaches which address the major conditions have been implemented in healthcare systems with positive outcomes for both patients and the NHS. Patients may be referred to creative programmes specific to their needs, either through their GP or acute hospital services, or they may independently access creative opportunities in the community or in their homes.

Given the benefits of creative health to patients and the health service, we would like to see creative health further embedded into health and social care systems. The establishment of Integrated Care Systems provides a good opportunity for health systems to form sustainable partnerships with creative, cultural and community providers, so that creative activities can become part of care pathways for people living with major conditions, and available to all. Creative health is also a vital component of the wider health ecosystem, supporting prevention and upstream approaches to keeping people healthy, and addressing the social determinants of health that lead to health inequalities. The importance of these activities to reduce the burden of major conditions in the future should be recognised in the Major Conditions Strategy.

Work is ongoing in our NCCH ICS Hubs to develop models and ecosystems through which creative health can flourish. Our new creative health associates, based in each of the NHS regions in England will progress this still further. The forthcoming recommendations from the Creative Health Review will make the case for cross-governmental support for creative health, to keep people healthier. You can find out more about our activities here.