1. The Welsh NHS Confederation welcomes the opportunity to respond to the Culture, Communications, Welsh Language, Sport and International Relations Committee consultation into its priorities for the Sixth Senedd.
2. The Welsh NHS Confederation represents the seven Local Health Boards, three NHS Trusts, Digital Health and Care Wales and Health Education and Improvement Wales (HEIW). We also host NHS Wales Employers.
3. Since September 2017 the Welsh NHS Confederation has had a Memorandum of Understanding (MOU) with the Arts Council of Wales. The aim of the MOU is to raise awareness of the benefits that the arts can have on people’s health and wellbeing and to embed arts and health initiatives across the NHS in Wales. This infographic summarises what has been achieved since the MOU was signed.
4. On behalf of our Members, we are calling on the Committee to undertake an inquiry into the role that arts and culture can have in supporting people’s health and wellbeing. When the Culture, Welsh Language and Communications Committee held a public poll in the Fifth Senedd to choose a new inquiry subject in the Summer of 2018, 17% of people who responded wanted an inquiry considering how using the arts can improve health and wellbeing. This was the 3rd most popular choice. Through the Committee undertaking an inquiry into arts and health it will consider the evidence that is currently available and the barriers to further implementation across Wales.
5. In addition, we are calling for an inquiry across all Senedd Committees on tackling health inequalities in Wales. Health inequalities are the result of many and varied factors. For too long, we have looked to the health service to address these challenges in isolation, but the NHS alone simply doesn’t have the levers to make the changes we know are vital to creating the conditions necessary for good health and wellbeing. Meaningful progress will require coherent efforts across all sectors to close the gap and an inquiry undertaken by all Senedd Committees will enable Committees to consider what action each Welsh Government department is doing to tackle the root cause of health inequalities and put forward recommendations around where improvements are needed.
What is the current impact of the COVID-19 pandemic on your sector, and what further support is needed from the Welsh and UK Governments both to mitigate the impact of the pandemic and enable the post-pandemic recovery?
6. The response to COVID-19 could not have happened without the excellent partnership working across Wales with local government, public sector, the voluntary sector and the private sector. In addition to working closely with health and social care colleagues, we have also raised awareness of the significant positive impact that the arts and creative activity can have on people’s health and wellbeing, especially in relation to loneliness and social isolation during the time of lockdown restrictions. In May 2020 and July 2020, we worked closely with the Arts Council of Wales and the Wales Arts Health & Well-being Network (WAHWN) to develop and publish briefings highlighting how the arts are supporting the Welsh health and social care response to COVID-19. The briefings also highlighted the significant impact that the pandemic has had on artists and the arts industry.
7. The annual turnover of the arts industry in Wales is around £2.2 billion a year. The sector employs 56,000 people, many of whom work as freelancers. As the sector is reliant on people coming together in close contact, it has faced some of the most hard-hitting structural challenges of any industry. Shutting services and closing doors to the public, coupled with the feeling of isolation, has meant that many artists have found themselves in financial difficulties, despite interventions such as the Furlough Scheme, the Self Employment Income Support Scheme and the Arts Council of Wales’ Arts Resilience Fund with its urgent response fund for individuals. The economic impact and the wellbeing of artists should be considered by Welsh Government in any COVID-19 recovery proposals.
8. The introduction of social distancing, self-isolation, and lockdown policies meant that many, if not all, arts practitioners in Wales had to change the way they provided their services. Many arts organisations and practitioners switched to delivering services online and, at pace, were able to implement digital service techniques such as online classes through platforms such as Zoom, YouTube, and various social media channels. This was an effective way to ensure people remained connected to each other and still engaged in artistic, creative activity.
9. Throughout the pandemic, Health Boards continued to work with their Arts Co-ordinators as well as working with commissioned artists. These relationships played a vital role to ensure that a strong connection with the arts was maintained for both recovering patients and frontline staff.
What issues should the Committee prioritise in planning our work programme for the immediate and longer term?
Arts and health
10. One of the key priority areas is around the role that arts and culture can have on supporting people’s health and wellbeing, therefore we are calling on the Committee to undertake an inquiry on this area. Through having an inquiry into arts and health, it will consider the evidence that is currently available around the benefits the arts have on people’s health and wellbeing and the barriers to further implementation across Wales.
11. Over recent years, Wales has led the way in developing arts and health initiatives which enhance the lives of the most vulnerable in society, keeping people healthy and close to their communities for longer. Research highlights that access to arts opportunities and participation in the arts can dramatically improve health outcomes and wellbeing, counter inequalities and increase social engagement. As a supplement to medicine and care, the evidence suggests that engagement with the arts can improve a person’s physical and mental wellbeing. The benefits of arts activities are being seen beyond traditional settings, and their role in supporting communities and individuals who would otherwise be excluded is increasingly being recognised.
12. As highlighted within the Arts Council of Wales report, Arts and Health in Wales: Mapping study of current activity 2018, there has been a significant amount of work happening at an individual Health Board or NHS Trust level, with a number of positive examples of collaboration between Health Boards and artists. This led to the Welsh NHS Confederation developing and signing the first MOU with the Arts Council of Wales in September 2017, with the second MOU signed in October 2020. The MOU is an opportunity to develop joint areas of work that contribute to our shared goal of improving the awareness of the benefits that the arts and being creative can have on people so that they can lead more active, more equal and healthier lives. The agreed areas of work include advancing good practice; promoting collaboration, co-ordinating and disseminating research; and working together to identify how arts can contribute to people’s health and wellbeing, including the mental health and wellbeing of artists and NHS Wales workforce.
13. A lot of arts in health work happens at grass roots levels, in community-based programmes that address both the clinical and social determinants of health. There is a need to scale-up this work and increase public awareness and understanding of the role of arts in health. We need to encourage best practice, shared ethics, research and evaluation, while celebrating and supporting the passion and drive of the many arts in health activities that make a difference. As the Arts and Health Co-ordinator at Swansea Bay University Health Board recently stated, “What can be achieved by working in partnership and across sectors is exponentially greater than what we can achieve alone…. As one patient said to me recently, ‘Having live music on the hospital wards is the biggest transformation in health in years’. I call it bringing disruptive joy”.
14. We are calling for an inquiry across all Senedd Committees on tackling wider health inequalities in Wales. Health inequality is the result of many and varied factors. While COVID-19 has revealed and exacerbated pre-existing health inequalities, there have been many detailed and well-evidenced reports on health inequalities in recent years. In just the past year, many reports have called for system-wide action on health inequalities including the Welsh Health Equity Status Report initiative, Placing health equity at the heart of the COVID-19 sustainable response and recovery (Public Health Wales and Welsh Government), The Marmot Review 10 Years On (Institute of Health Equity and the Health Foundation) and the most recent Unequal pandemic, fairer recovery (the Health Foundation). Every one of these reaffirms the need for coherent, coordinated activity across all delivery partners, and in COVID-19 recovery there is an opportunity to create a healthier, more resilient society, by addressing the root causes of poor health and invest in people and their communities – their jobs, housing, education and communities.
15. Health inequalities are the result of many and varied factors and arise as a result of the social and economic inequalities that shape the conditions in which people are born, grow, live, learn, work and age. For too long, we have looked to the health service to address these challenges in isolation, but the NHS alone simply doesn’t have the levers to make the changes we know are vital to creating the conditions necessary for good health and wellbeing. Meaningful progress will require coherent, strategic efforts across all sectors – using their available resources, expertise and relationships – to close the gap. It will also be important that we are able to understand and measure our collective progress to ensure that we achieve the outcomes that matter most.
16. In April 2021, the Welsh NHS Confederation’s Health and Wellbeing Alliance published a short paper, Making the difference: Tackling health inequalities in Wales. In this paper, we suggest initial steps that the new Welsh Government should take to respond urgently to health inequalities and make the greatest possible impact by coordinating renewed commitment from all partners.
17. As highlighted within our briefing, How the arts can help address health inequalities, the arts have a key role in tackling health inequalities and it is important that those involved in delivering arts projects recognise that the groups most likely to experience unequal health outcomes are the same groups that have been historically under-represented in the arts.
18. There are a number of ways in which engagement with the arts can help to reduce health inequalities. For example, engaging in creative activity with members of the local community supports improved social integration, which, as evidenced in the first Marmot Review report, is one of the key underpinning factors that leads to good population health, particularly among less affluent groups.
19. While there are some examples in Wales of arts and health projects that aim specifically to increase engagement with the arts among marginalised and under-represented groups, the arts and health community still has some way to go to achieving a level playing field. Given we know how powerful engagement with the arts can be, an inquiry will act as a springboard for a new conversation that considers why engagement with the arts is lowest among those who may benefit most from it, and what steps we can take to bridge the gap in Wales.
20. Through having a cross-Committee Senedd inquiry, it will enable all Committees to consider what action each Welsh Government department is doing to tackle the root causes of health inequalities.