July 2021
Programme Update - Stepping out
It’s been a busy time in HARP as the projects and teams we are supporting are beginning to step out of ‘set up’ and into running sessions. We continue to be inspired by the innovation we’re seeing from the teams as they navigate ‘hybrid’ delivery (mixed online and face to face), evaluation briefs and a bruised health and care system. Their positivity, willingness to flex, develop and shift their own thinking, as well as their projects, is what makes HARP so exciting!
As shared before, in HARP we are working with 13 teams of arts and health partners working with us to seed, grow and sustain a big range of creative projects to support peoples’ health and wellbeing in Wales. You can find out more about our partners and places here.
Progress on HARP Seed continues, where we have been forming partnerships between health places and artists to test out new creative solutions to key health challenges. The teams have now begun testing their ideas: one team is collecting stories from Black NHS workers and another running creative focus group sessions for people who have experienced sexual violence. We’re excited by the concept of using creative methods to understand peoples’ lived experiences so that health and care organisations can design better support for them. Learn more about this in our spotlight below!
In HARP Nourish, we have been testing and flexing our approach to the coaching and learning elements we’ve set up for our 10 innovation teams. We have also continued to refine how we run our ‘learning groups’, who meet every six weeks to discuss five key topics that we feel we need to know more about in order for arts and health projects to become embedded in health systems. These are evidence, referral pathways, delivery, building shared understanding of value and funding. We’re getting some great conversations going in these sessions and are already making headway into building collective understanding about these key topics. We’re also seeing the simple power of bringing people together to share learning. Each month in this Journal we’ll focus on one of these topics and share what we’re learning, this month is Pathways!
Project Spotlight - New Pathways
New Pathways is a charity that provides support to people who experience rape or sexual abuse. In Wales sexual violence affects an estimated 70,000 people. Stigma and shame are huge barriers, and practical considerations in Wales like rural isolation, transport links and digital poverty are common; these particularly affect those with low incomes or from already marginalised groups. It goes without saying these are huge health challenges that affect many people.
There’s no typical profile for New Pathway’s client group, so a continual challenge for them is getting people to engage with their services in the first place. The organisation joined our HARP ‘Seed’ programme in Jan 2021, hoping to learn how creativity could help them engage people they perhaps wouldn’t otherwise. Supported by Y Lab and Nesta’s People Powered Results team, New Pathways built a cross-sector team to work on this health challenge. Their particular aim was to increase access in Mid Wales where agency/service referral (and self referral) numbers were low.
We cast the net wide through an open call for artists; in the case of New Pathways, Seed helped broker a new partnership with two fantastic artists (Jain Boon and Matilda Tonkin-Wells), who are trauma-informed and value the process of innovation and teamwork.
Matilda and Jain suggested the team approach the task by running creative focus groups, with new and existing New Pathways clients, in order to find out what sort of creative activities might interest them, help to reduce stigma and help New Pathways to find more people that need support.
Whilst the organisation is used to running consultation or information sessions, the idea of incorporating creative activities into these has opened up a different kind of communication with clients, encouraging people to share more freely, safely and creatively about their experiences, positioning risk in a safe way. The hope is that the team will next develop some creative outputs - possibly art works, films or podcasts, added to a 'Client's Corner' page on their website that can be publicly shared to help others needing support find the strength to come forward. New Pathways perceive that even attending the focus groups has been powerful and empowering for their clients and staff, who have requested that they continue meeting to support their recovery. Most importantly, having taken the bold step into arts and health, the organisation is already engaging with other creative projects and activities to raise awareness of their support services and tell the stories of people affected by sexual violence. They are also exploring new and different funding streams.
In turn, we’ve learned a lot from this team about how different impact can look in organisations. For example, impact for New Pathways can mean anything from saving a life to just getting someone to peek through their curtains and take that first step to reconnecting with the world. New Pathways’ Deputy CEO has said they are committed to sustaining the ideas that work from their own core funding, as well as also sharing the learning with other health and care organisations so they can replicate the work they’ve done, leading to more lives being changed - and many more curtains being opened.
Learning points this month: Pathways
As the New Pathways story illustrates, a big aspect of delivering participatory arts and health projects is being able to make contact with people who may wish to take part in your project. There are a number of ‘referral’ routes, and this month we’ve been thinking about the growing national interest in so-called ‘social prescribing’, a movement that enables health and care professionals to refer people to a range of local, non-clinical services to support their health and wellbeing. The movement presents big opportunities to provide more holistic approaches to health and care, however, it’s a challenge to shift the administrative processes of health and care organisations to a place where people are routinely offered non-medical interventions for their health. Through our work with the HARP teams, we’re seeing the following themes and challenges emerge around this topic:
The philosophical leap: the concept of social prescribing requires significant cultural shifts for both health and care professionals and the people they care for. Adopting a view that social and cultural activities can prevent or help to manage ill-health requires a philosophical leap for those of us who traditionally go to the doctors just expecting a simple ‘fix’, such as a pill, bandage or operation. It means blurring the boundaries around health and care systems, viewing our health - particularly our mental health - as a multifaceted thing, influenced by all areas of our lives. It’s this space that arts and health projects generally occupy, so our approach in HARP to supporting arts and health organisations to work in partnership will hopefully help to shift these narratives.
Whose responsibility is social prescribing?: Here in Wales we have a strong basis for making this leap: our Wellbeing of Future Generations Act, which is seen as a progressive, holistic policy approach to keeping us well. The next step is how we enact this in the case of social prescribing. In England, the NHS has funded ‘link workers’ for primary care (GPs) across the country. However in Wales, there’s a more locally responsive approach; some areas have set up community connection services in the councils, others have outsourced this to voluntary associations, whereas some health boards have also favoured the England-like primary care route. These approaches aren’t mutually exclusive, they can co-exist in certain areas and even job titles vary: Area Coordinator, Social Prescriber, Community Connector. This local focus has some benefits for arts and health practitioners, in that it allows local people, networks and providers to take the lead; however in practical terms it can also be a hard system to navigate, as well as being somewhat patchy across Wales (so some areas have better provision than others). There’s also a belief amongst some HARP teams that local authorities or voluntary associations are perhaps better placed to perform this work than health boards, as their smaller populations and broader remit make them better placed to think more holistically about health and wellbeing.
Resourcing: In the post-crisis period after Covid, health and care systems are dealing with a backlog, a burnt out workforce and a huge increase in isolation and poor mental health. Arts activities could play a huge role in both alleviating pressure on the system, and helping people more meaningfully than just ‘firefighting’. Our HARP teams are learning that, in order for a social prescriber or community connector to facilitate participation for people in arts activities, they need to invest time in navigating what’s available and boosting peoples’ confidence to make that philosophical leap and engage with something new. At the heart of this is relationships. In some HARP projects this works well: community connectors even attend projects with people, sort out tech needs for online projects and just hold peoples’ hands, which makes all the difference. However, others report that community connectors are too swamped to do much more than give people a number to call, which is often not enough. The message from our HARP teams is that investment in a greater number of community connectors could reap long term benefits for people and reduce pressure on systems.
Consistency and funding: From community connectors’ points of view, a key aim for them is to connect with community arts organisations and arts and health projects that they can rely on to be a) high quality and b) maintained long term. But without clear routes to sustainability, arts and health projects can prove to be an unreliable place to refer people to. What happens if a person finds an arts project life-changing, but then that service quickly comes to an end? Isn’t it just better not to refer in the first place? Some believe that alongside funding for their teams, it would help significantly if reliable long-term core funding was available through local authorities and Voluntary Organisations to maintain arts and health groups who otherwise may not survive.
National networking and knowledge sharing: The de-centralised, local approach to social prescribing / community connecting in Wales has many benefits, but could itself benefit from having a central, national coordination or networking point in order to develop national knowledge, skills and evidence. A hub that collects and shares information, analysing data and organising training events or conferences would require limited investment but could really help community connectors develop their practice, as well as giving arts and health providers a place to help them navigate who to contact in their own local area. The HARP learning group for pathways has in itself already proved a very useful space for sharing challenges and opportunities in this area.
Next time we will be looking at innovative arts and health delivery models.
Interesting Links
- As the COVID-19 pandemic worsened over the winter of 2020, and the pressure on NHS staff has increased, Amgueddfa Cymru took the national art collection into hospitals to provide solace for staff and patients: Famous Welsh Landscape, views of Wales used to decorate NHS hospitals in Wales for wellbeing
- University College London are running a free online course to help you develop, deliver and evaluate health and wellbeing work within a museum, arts, heritage or cultural organisation: Culture, Health and Wellbeing: An Introduction | Short courses
- Find out more about the HARP Nourish supported project Ar Y Dibyn - a Welsh-language creative course for people experiencing substance misuse, delivered by Theatr Genedlaethol Cymru and their partners. There’s a call for both artist facilitators and participants here.
HARP is funded by Arts Council of Wales through the National Lottery. It is delivered by Y Lab, a partnership between Nesta and Cardiff University, supported by Wales Arts, Health and Wellbeing Network and Welsh NHS Confederation.
