HARP Journal: November 2021

Welcome to the HARP Journal!  Here we will share news and emerging learning from the ‘HARP’ (Health, Arts, Research, People) programme each month during 2021-22. This month’s theme is Delivery.

Programme Update

Autumn often feels like a time of reconnecting, and in HARP it’s been no exception. Many of us have been enjoying getting out and about a bit more after lockdown, meeting people face to face and occasionally enjoying some crisp autumnal sunshine. But Covid-19 is still very much with us, and here in HARP our teams have much to navigate as they consider how to make the most of the increasing opportunities of face-to-face interactions, whilst still minimising risk and ensuring ongoing accessibility for people who can only engage online.

In September we resumed our HARP Nourish learning groups online again each week, to discuss our five key ‘learning topics’ ( evidence, referral pathways, delivery, building shared understanding of value and funding). We continue to see the effects of the pandemic on all of these areas – with both challenges and opportunities aplenty. We’re particularly inspired by the teams’ ability to forge and maintain new partnerships between health and arts partners. For example, the project led by Theatr Genedlaethol Cymru is now exploring working jointly with new partners such as Shelter Cymru in order to expand upon the groups involved in the ‘Ar y Dibyn’ (‘On the Edge’) creative project. These creative workshops were originally set up for people with substance addiction, but the intention now is to extend them to help women experiencing homelessness and domestic violence (see our Spotlight below for more information on this project). At HARP, we’re thinking now about how we start to synthesise what we are learning and testing in these groups and share it out more widely, as well as encouraging our teams to start focusing on what they can control and test, in a world where there are still so many things they cannot.   

In HARP Seed, the teams have done some amazing work over the past two months. Our New Pathways team, featured in the July issue, has now launched their ‘Messages of Hope’ exhibition online, featuring artworks from people who have experienced sexual violence. The team are now mid-campaign to get the website shared far and wide, helping them to reach more people affected by rape and sexual abuse, particularly in mid-Wales. Our Health Education and Improvement Wales (HEIW) Seed team have now collected and recorded 10 stories from Black NHS workers into an audiobook which will be published in the next month.  The stories are incredibly powerful and we are supporting HEIW to now think about who to share them with, and how, in order to make sure the lived experience of Black NHS workers remains central not just to their inclusion work, but across more areas of NHS workforce development.  Being alongside these innovations right from the inception has taught us so much about how health partners can build their capacity to work with artists and really be open to challenge and change in some of their most deep-rooted system challenges. It’s not easy but it is possible!

Each month in this Journal we’ll focus on one of these topics and share what we’re learning, this month is Delivery.

Project Spotlight – ‘Ar Y Dibyn’

Ar y Dibyn’ (‘On the Edge’) is a partnership project set up before the Covid-19 pandemic, specifically in response to the need for Welsh medium support for people who are dependent on substances.

It is vitally important to be able to access support services in your first language, but many statutory bodies find it difficult to offer services in Welsh. Living with dependency, by its very nature, means that it encompasses and affects a wide cross-section of our public services – health, care, housing, the third sector.  Working through a combination of online and face-to-face conversations, with Lead Artist, Iola Ynyr and other artists, Theatr Genedlaethol Cymru, Literature Wales and Adra (Housing) and the North Wales Substance Misuse Planning Board have developed their Egin project with a wide range of new partners including Stafell Fyw, Adferiad and North Wales Recovery Communities, to name but a few, to develop a project that works with people across the whole of Wales.

The project is run in the form of creative workshops to celebrate the possibilities of life, rather than the barriers of dependency. The aim of the workshops is to promote creativity to process people’s experiences of the world. Each workshop includes short playful tasks to ignite the imagination and release ideas. There are no wrong answers, just endless possibilities.  One participant said: ‘Fear held me so tightly in its grip, and I didn’t tell a living soul, apart from my husband, that I was going to the workshops. Fear, shame, nervousness. . .but by the end I was looking forward to coming to the next session. I didn’t have an “end goal” I just wanted to give myself time and space to get better, to be in a room with other people like me, people who understood, and to have the opportunity and space and permission, in a way, to be myself, in my own language.’  The team will develop powerful, courageous and ambitious work that comes from the heart, and find ways of spreading the work widely to try to reduce the stigma around addiction and encourage people to seek help. 

Qualified health specialists are available to advise during and after each session as necessary, this is an important part of the project’s pattern and reflects the partnership working on which it is based.  Early reflections by the partners indicate the importance of the project’s existence; partners have told the team that the project is helping the health service deal with its waiting lists for dependency support by offering people somewhere to go in the meantime, as well as closing the gap in Welsh language provision. The partners in the housing associations hope that the project will help residents to better sustain their tenancies by putting them on the road to recovery from their dependency, and the Regional Substance Misuse Partnership in North Wales is helping to refine the routes to the project by ensuring that people from their agencies are referred directly to ‘Ar y Dibyn’ sessions.

The ambition is that ‘Ar y Dibyn’, through these partnerships and new partnerships, will become a long-term, incorporated provision for anyone with substance dependency in Wales.  HARP support and funding helps Iola Ynyr to train more artists to run the sessions, to think about the project’s income model and their evaluation (it has been impossible to find a Welsh speaker to evaluate the project from the outset, so we have helped the team deal with the evaluation internally) and to help them identify and collaborate with new partners and locations all the time. The team has also developed their ability to run the sessions very flexibly – some are completely on-line, some are entirely face-to-face and some are a mixture, with face-to-face sessions in Cardiff whilst the artist and other participants dial in from across Wales. This makes the project a rare, successful, Welsh medium national arts and health provision with real scope, quality and impact.

Learning points this month: Delivery

Of all our Learning Topic areas, one significantly impacted by the Covid-19 pandemic has of course been delivery, by which we mean how arts innovations for health and wellbeing are facilitated by practitioners and experienced by participants.  Through our work with the HARP teams, we’re seeing the following themes and challenges emerge around this topic:

Hospital or community delivery: As we have seen a lessening of restrictions, it has once again been possible for artists to go into hospital and care settings for face-to-face work with patients. This is closely monitored and artists’ access changes week by week depending on Covid outbreaks, but we are seeing work happening more consistently, bringing much needed life and joy to what has been such a tough environment for patients and staff in the last 18 months. Somewhat surprisingly, some of our HARP projects are finding that community-based sessions in person are proving much more difficult to get started.  They have reflected that one reason for this is that the hospital setting already has Covid risk assessment and mitigation processes, whereas community venues are not set up to allow social distancing, or simply haven’t reopened yet, so it’s proving much more difficult to ensure a Covid-safe environment for vulnerable participants.

‘Hybrid’ arts and health sessions: Some of our teams have been experimenting with what’s known now as ‘hybrid’ delivery – where some participants get together in a room and others are present via an online connection.  This enables participants to have more choice and agency in terms of how they engage with each other (and artists), as well as having practical benefits for practitioners wanting to open their sessions up to more people in a wider geographical area.  These modes also provide a level of flexibility and stability whilst we continue to navigate changing restrictions.  Of course, the artist must develop new skills to be able to reach and include people equally across the two settings, and for some artforms – especially music – this can be quite challenging. However for writing, storytelling and visual arts this mode can be very effective.

Remote delivery is here to stay: For people who are less mobile or cannot drive, who have physical or cognitive impairment and live in rural settings with poor transport links, the development of so many new and improved remote delivery models for creative activities can definitely be seen as a positive thing. Arts organisations and artists have invested more time than ever in this pandemic period into making online experiences the best they can be, sourcing new equipment and working with creative technologists to ensure elements like sound, camera angles and lighting enhance the experience for participants.  There’s also been a renaissance in art packs by post, a simple but highly effective way of supporting people to take that first step into creative activities in their own home by providing good quality materials and well thought out tasks. It remains challenging to recruit new participants to online settings, and building trust and connection in the same way takes a lot of time and energy, especially for the most vulnerable people. However it’s encouraging to see the mainstreaming of these methods; after all, many people were isolated from face-to-face engagement well before the Covid-19 pandemic, and will be into the future.

Next time we will be looking at how we build a shared understanding of value between health and arts sectors to make the case for long term support.

Interesting Links

  • Creatively Minded: The Baring Foundation has released a report on arts and mental health provision in healthcare settings. The report features case studies from across the UK, with a special focus on Wales, where the Foundation is now working in partnership with the Arts Council of Wales to fund more work in this area via the seven health boards.
  • How ya doing? The Wales Arts, Health and Wellbeing Network has launched a new programme, supported by Arts Council of Wales, aimed at providing creative support to practitioners working in arts and health.
  • Build back better: We were pleased to hear Phil George, chair of the Arts Council of Wales, share his reflections on the role of arts in reducing health inequalities at the recent Welsh NHS Confederation lecture series. The lectures featured a range of high profile speakers exploring how Wales can lead the way in tackling health inequalities and sustaining the innovation and creativity displayed in the NHS over the past 18 months, whilst also facing such huge ongoing challenges.

HARP is funded by Arts Council of Wales through the National Lottery. It is delivered by Nesta and Y Lab (Cardiff University), supported by Wales Arts, Health and Wellbeing Network and Welsh NHS Confederation.