Happy now. “ The concept of the dusty museum has long gone. Our central purpose is... to stimulate, to listen, to teach, to excite and to inspire. Mostly we want visitors to feel welcome, comfortable and positive.” Emma Varnam, Tameside’s Head of Museums and Galleries “Museums are in the ‘life-changing’ business,” according to Emma. “Getting up in the morning and going to work is an opportunity to create ‘moments of magic’ in our visitors’ lives,” she wrote in a recent report. These ‘moments of magic’ have given their name to Tameside’s community programme for museums and galleries. It is a programme that has seen the service directly engaged with the health and wellbeing of residents. In practical terms, Tameside’s programme has included a mass ‘Knitting Together’ activity where more than 100 people aged from 3 up to 90 years created a collaborative, knitted artwork that depicted the borough’s canal network. There has been a photography project with young carers that built their self confidence and self esteem. There has been a roaming exhibition on healthy lifestyles called ‘Fit for Life’ that has been visited by 53,380 people. And there’s been yoga in the art gallery. It’s a picture being played out right across the North West. Museums and galleries have got a strong story to tell as they work with health service providers to keep local populations mentally stimulated and physically active. We are in Alder Hey 1
Children’s Hospital; in care homes for the elderly in Carlisle; in an academic health research-unit in Preston; partnering mental health charities in Manchester and GP surgeries in Nantwich & Bolton. We’ve even won awards for it. The partnership between National Museums Liverpool, Liverpool PCT and mental health centre Mary Seacole House was a winner in this year’s Guardian Public Service Awards for a project which has boosted the confidence of vulnerable and isolated older people, and helped them feel personally connected with the City and its history. Just being good at the work is no longer enough. That’s why the Renaissance NW Who Cares programme is evaluating a wide range of regional programmes to determine best practice, health priorities, hard outputs and impact. The challenge for our region’s museums and galleries is to respond to local needs against a backdrop of significant change as set out in the 2010 White Paper: Liberating the NHS and further to the Comprehensive Spending Review. Firstly, whilst Local Authorities will continue to have primary responsibility for coordinating social care activities, major cuts suggest that in the future they will be more tightly focused on those who have either ‘critical or substantial need’. In this scenario the broader preventative work that many museums have been so active in may lose out. We will need to become ever more expert and specialist, adapting our programmes, our knowledge and our expectations to suit. A good starting point will be understanding the ‘Joint Strategic Needs Assessments’ that already exist across local authority areas . A second urgent need is to make sure that the case for arts in health is being made at the right level. With the passing of Primary Care Trusts, existing champions of museums work may no longer be driving programmes and few areas have NHS Arts in Health Co-ordinators. In the new NHS, GPs become a more important advocacy target as they will have control over budgets and patient choice. Yet the majority of GPs remain unaware of the work we do and the impact which it can have.
Increased patient choice over health care options, or ‘personalisation’, is taking root. Yet do people know that alongside conventional therapy, museum and gallery options exist? From independent visits to participative workshops, volunteering programmes to drop-in events such as dementia cafes, we have a huge amount to offer individuals outside of the social-care setting. We need to find ways to communicate our whole offer to patients, their care-workers and GPs. We need to position ourselves to mental health, care of the elderly and good parenting, as sports centres are to preventing obesity and cardio vascular disease. But as museums are discovering, even where there is advanced work to build on like in Bolton and Stockport, this is not a small activity. Following the model adopted by libraries with their ‘books-on-prescription’ networks, targeting healthcare professionals and working via established referral partners may have greater influence and reach than we can achieve alone. Any case-making we carry out will have to measure value for money according to health and social care outputs: like offsetting future healthcare costs, demonstrating increased independence, reduced hospitalisation and fewer prescribed drugs, therapy sessions or referrals. We need a nationally agreed framework for measuring – a concept that has traditionally proved tricky to achieve. This will require us to fundamentally rethink our practices so that this work is embedded and sustainable, working with people for the long-term, not driven by short project-funded cycles. At MEAL, Tony Butler argues that museums focus too much on trying to demonstrate how they contribute to driving economic participation, at the expense of what they do best – bringing people together in social networks, in welcoming, safe spaces, and cultivating moments of kindness, connection and support. A Happiness Associate is to develop thinking around how MEAL and other museums can fully become high-wellbeing organisations. Whichever approach is taken - new partnerships, high concepts or senior level case-making, the need for interventions has certainly not gone away. The North West Health Profile for
2010 describes a region significantly worse than the rest of England for 20 of the 32 health indicators. It highlights two specific challenges to improving health in the region: reducing the numbers of hospital admissions for alcohol-related harm (8 of the 10 Local Authorities in England suffering the highest levels of alcohol related harm are in the North West) and mental illness, for which incapacity benefit claims continue to be the highest in England. Stark differences across the region mean that those living in disadvantaged circumstances are affected most, have substantially reduced levels of wellbeing and need the greatest intervention. The museums and galleries sector can play a prominent part in delivering better health outcomes: their contribution will enhance and save lives, but will also rescue resources from a hard-pressed National Health Service. Wellbeing remains a national priority, and here perhaps museums and galleries have been dealt their trump card. The New Economics Foundation (nef) has crafted its 5 Ways to Wellbeing, as an alternative ‘five a day’ for good mental health – advocating a daily dose of connecting, being active, taking notice, keeping learning and giving as the key to a happy life. Welcoming ‘third spaces’, loved by their communities, stuffed full of fascinating and absorbing objects, stories and activities, with a diverse user base, social values and inclusive opportunities – museums are an obvious fit for nef’s vision for wellbeing.
So what steps could you take to be a positive partner in the new, restructured Health Service? A few, small steps to take could include: One. Understand our impact.
The seminal publication Museums of the Mind offers a wealth of evidence on how museums and galleries can play a positive part in delivering health and wellbeing. Share the evidence, review it and lay out your own case . Two. Know the terrain.
Refresh your contacts, and make some new ones. The hands on health’s ‘purse strings’ are set to change and any museum or gallery wishing to engage should get up to speed on the changing shape of the sector, starting with the Coalition Government’s 2010 White Paper: Liberating the NHS , where the shift is towards personalisation and the intention is to move the NHS money and commissioning base to GPs. Local Authorities will be responsible for health improvement budgets and for overseeing the partnerships integrating health, adult social care and children’s services. All hospitals will become Foundation Trusts, and Regional overview bodies and ‘old’ commissioning bodies like the Primary Care Trusts and Strategic Health Authorities will be phased out. At a practical level the shift and a growth in commissioning will be most relevant to us. The NHS will pay and tender for more services by results, rather than be the default provider of services itself including community health services delivered by independent providers, such as the voluntary and community sectors and social and private enterprises. This approach will be explored in adult social care, early years and community health services – the things we can help deliver. 5
Three. Shout about your work to date.
It’s time to represent the work in your area that’s been done on health wellbeing with simple, timely and relevant information for local partners promoting what you are doing. A great example here is Tameside’s Magic Moments report. There is no guarantee that the advocates and champions you may have fostered in the health sector to date will still be your key contacts in the future. It’s time to repitch! Oh, and pitch in the right language: art-on-prescription, dementia cafes, museotherapy, social-prescribing. Four. Expand your range of partners.
We need to remember that we are only a small part of the arts-in-healthcare world, which in turn is only a tiny part of the social and public health care spectrum. Other agencies will be targeting GPs too. We should seek to establish relationships with bigger, more networked partners like Samaritans, Age UK, MIND, local volunteer groups, and work with them. Use their influence to help protect NHS funds for local providers. Use on-line resources like creative-remedies website or North West Arts Health Network to source other partners. Five. Practice your ‘hard language’.
It won’t be enough in the future to provide the soft evidence stories of how people come to terms with and manage their health conditions. Adopt the measures of the sector. Shape and use emerging Happiness Indices. Follow Five Ways into Wellbeing. We have to quantify and demonstrate that by funding museum and gallery activities from social care budgets, expenditure further down the line is saved. The use of tariffs and more innovative payment mechanisms will be brought in and we need to know how we compare with other prescription options in terms of cost effectiveness.
Museums have made a real and tangible impact on health outcomes in the last few years and it is work that will and should continue; the changing context and straightened resources will be challenges, but ones that can be overcome if a strategic and thought through plan of action is put into play.
Personalisation, increased patient choice and self-managed budgeting bring with them massive opportunities for museums and galleries. But the management implications for GPs are huge and they are likely to find one-stop-shop solutions more appealing than working 1:1 with small suppliers like individual museums. Creative Health is a recently established community interest company which helps NHS, LA commissioners and patients in the West Midlands meet their priorities and targets. It advocates centrally and clusters its projects to demonstrate increased impact. Is it possible for us to develop a similar coordinated one-stop-stop for creative-healthcare commissioning in the North West? Might this be a quick win for the new structural relationship with Arts Council in bringing arts and museums more closely together?