Arts & Healthcare

5.20 pm

Lord Mawson: I congratulate the noble Lord, Lord Howarth of Newport, on securing this debate. It is a subject very close to my heart and an area of work I have actively promoted for many years through my work at the Bromley by Bow Centre in the East End of London. I declare an interest as the founder of a centre that has spent 25 years exploring the relationship between the arts and healthcare in the midst of a challenging group of East End housing estates where traditional approaches to health, which have followed the biomedical model, have been far from satisfactory and very costly.

The key question is: what does it mean to be a healthy and fully rounded human being and what kind of services do we need that will help, rather than hinder, such human development? More precisely, do we want to develop a National Health Service or, as I fear we have at present, a national illness service? Yes, it is a fairly good national illness service, but it is expensive and wasteful to focus on illness rather than health.

The problem with an illness service with an ageing population is that the demands upon it are potentially infinite, particularly given the tendency endlessly to pathologise; for example, on happiness, food or weight. The NHS treats these matters as illnesses rather than giving enough thought to how to promote health. Through working with artists and creative people, social entrepreneurs like myself have learnt how to turn these problems into opportunities for health.

One of the reasons we involved artists from a very early stage in people’s healthcare in Bromley-by-Bow, apart from the fact that you can give an artist a derelict room and they think they are getting the earth, is that they bring a space alive. They bring life, health, energy and transformation and they believe

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that everyone is creative and has potential. One of the key roles of an artist is to engender change and transformation. What does this mean in practice in our health centre in Bromley-by-Bow?

The Bromley by Bow Health Centre has GPs who work alongside artists and a multi-disciplinary staff team who can offer our patients more than 125 different activities each week, the arts being among them. A few of our medical staff are also practising artists. I could give many examples of how they have used the arts to tackle pressing clinical problems such as diabetes, vaccination take-up and iron deficiency anaemia, but there is time for only one. A while ago a number of our doctors began to notice an increase in asthma among our young patients. The traditional response would, of course, be a three-minute appointment and the calming of parents’ fears with the usual medication for their child. The centre’s response was to turn the problem into an opportunity for health promotion.

A 10-week course for children with asthma aged five to 11 years was established, run by a practice nurse who was also an artist. She worked alongside one of the centre artists and local volunteers. The course was run after school in the health centre reception, which doubles up as an art gallery, and was attended by 12 to 15 children at a time with their parents. Seeing your child experiencing breathing difficulties is frightening for all parents, particularly if you have no scientific understanding of what is happening in your child’s body. First-year medical students on a special study module placement at the centre were also invited to take part.

The workshops were designed and run in three phases: monitoring asthma, trigger factors and controlling asthma. Each week the art produced from the session was hung in the reception area, thus creating an instant involvement with all the participating children and, of course, with other patients. All the children were given a peak-flow diary and recorded their peak flow for the duration of the workshops. During that period the children produced blow paintings with stencilled airway shapes, made airway mobiles and created models of allergens that cause asthma, showing the role played by cigarettes, house dust mites, spray cans and the like. They sculpted a large bronchial chandelier with inhaler colour coding and produced an asthma space station from empty inhalers.

Each of the workshops had an educational component integrated into the art-making activity, and the facilitators ran quizzes to establish levels of knowledge around each of the asthma areas. The findings and benefits were that there was excellent feedback from the children, with clear improvement in their asthma management. The project was evaluated for its impact on the children and their parents, and all the children showed a marked impact to their peak flow. Surgery staff were involved in the reception and the conversations that the exhibition stimulated among patients, local people and staff were countless. Knowledge about asthma, through the medium of art, increased; fear about a frightening illness decreased. Those are clear positive clinical

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outcomes with equally clear economic benefits to the health service. However, there remains an important need for research into the costs and benefits of that type of intervention. I am told that it would be straightforward to set up clinical trials to gather evidence as to whether or not they are effective.

A number of important unintended consequences also occurred. Parents began to understand the science of their children’s illness, and were thus less fearful and could respond accordingly. Parents, trainee doctors and members of staff came to know each other on first-name terms and new relationships were built between professionals and local people. Who knows which of those East End children might now be thinking about becoming a doctor or nurse in their later life? Who can tell? Indeed, at least one of the medical students was switched on to the idea of a career as a GP for the first time, rather than focusing on the supposedly more glamorous idea of a hospital-based career.

Was the whole exercise about health, the arts, science, education, social care or relationships? Actually, it was about all of them, but none of them in a box. Does it have implications for the noble Lord, Lord Darzi, and his thinking about polyclinics? I hope so, because the Bromley by Bow Centre is probably the first polyclinic. But who knows? Was it cost effective? Yes, and no prescriptions were given out. The final twist was that, as social entrepreneurs, we realised that we could package the course, turn it into a business opportunity, sell it to every school and health centre in the UK and use the money to fund other health projects at the centre.

A key to our success in Bromley-by-Bow was not to use artists who just came in to do things with patients but to encourage artists to live out their real work as artists at the centre. It really works when artists become part of the health community. They live their lives there and have studios there, and their passion for their subject inspires others.

To maximise the opportunities presented by the reforms of the noble Lord, Lord Darzi, we will need to ensure that we provide a health service rather than just an illness service—a service that is about more than just the biomedical model of health, which is very expensive. Twenty-five per cent of patients who have traditionally been seeing our doctors did not need medical help; they needed something else, but ended up with a medical response by default. If all you have is a team of clinicians, whether they are in big central hospitals or dispersed through smaller centres and GP practices, the health service will change very little. This is all about clinicians giving away power and about a broader view of health. What is radical about our work in east London is that doctors and nurses have shown some humility and have been willing to share power with others. Simple things such as a shared reception save so much money.

The £300 million healthy living centre programme was full of opportunities to expand this thinking when it was boldly launched by Ministers in 1997, but it is in danger of withering on the vine because local clinicians were not actually prepared to give up fiefdoms and engage. Institutionally in all its forms the NHS and

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the Department of Health singularly failed to engage with this important opportunity. One suggests that all that they saw was yet another demand on their resources, rather than an opportunity such as that described in our asthma project, to reduce the drugs bill and the number of hours that expensive clinicians have to spend with patients.

In my experience, connecting the arts and health is good for patients, builds a healthy and dynamic staff team and is very cost-effective. I hope that the report by the noble Lord, Lord Darzi, will embrace this opportunity, which we have spent over 20 years successfully demonstrating.